Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients
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RESEARCH ARTICLE
Gastrointestinal complications are associated with a poor outcome in non‑critically ill pneumonia patients Chun‑Ta Huang1,2* , Chun‑Ming Hong1, Yi‑Ju Tsai3, Wang‑Huei Sheng1 and Chong‑Jen Yu1
Abstract Background: Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. Methods: Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. Results: A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065). Conclusions: Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay. Keywords: Complication, Gastroenterology, Pneumonia, Prognosis, Readmission Background The gastrointestinal (GI) tract is the largest organ system of the human body and exerts a variety of physiologic functions during a normal state. Other than serving as a digestive conduit, the GI tract also plays an important *Correspondence: [email protected] 1 Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung‑Shan South Road, Taipei 100, Taiwan Full list of author information is available at the end of the article
role in immunomodulation, hormone control, fluid and electrolyte balance, and physical protection from ingested environmental threats [1–3]. During the period of critical illness, GI complications may occur as a result of diverse injurious mechanisms, such as hypoperfusion, ischemia–reperfusion injury and pro-inflammatory cytokine responses [1, 4, 5], and these complications are linked to increased mortality and morbidity among patients suffering from them [5,
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