通过不同标准对危重患者腹泻进行分类:一项队列研究。

IF 4.7 2区 医学 Q1 CRITICAL CARE MEDICINE
Ryohei Yamamoto, Hajime Yamazaki, Takatoshi Koroki, Yuna Ueta, Ryo Ueno, Yosuke Yamamoto
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引用次数: 0

摘要

背景:缺乏对危重患者腹泻的一致标准提出了挑战,包括不确定的患病率和关于腹泻对死亡率影响的不一致的发现。本研究旨在探讨腹泻的患病率,不同诊断标准之间的一致性,以及它们与死亡率的关系。方法:在2017年1月至2018年12月期间连续入住重症监护病房(ICU)至少3天的成年患者中进行单中心队列研究。评估的6个腹泻标准是基于频率、数量和一致性。这些标准包括欧洲重症医学会(ESICM)标准(≥3次和200克/天稀便或液体便),世界卫生组织(WHO)标准(≥3次稀便或液体便),布里斯托尔大便量表(BSCS)评分为6或7,以及其他基于数量或频率的定义。结果包括:(1)根据每个定义的腹泻患病率,(2)标准之间的一致性,以及(3)腹泻与住院死亡率之间的关联。使用多变量Cox比例风险模型评估相关性,得出风险比(hr)和95%置信区间(ci)。结果:在700名参与者中,61%是男性;中位年龄为71岁。根据所采用的标准,腹泻的患病率从9%到39%不等。WHO和ESICM标准显示相似的患病率(分别为18.7%和15.1%)和高一致性(Kappa 0.87)。然而,两者与BSCS标准的一致性较弱(患病率39.3%;Kappa分别为0.52和0.43)。在单变量分析中,无论采用何种标准,腹泻的存在都与住院死亡率相关。在多变量分析中,只有> 400 g/天稀便或液体便,> 200 g/天稀便或液体便和BSCS标准保持这种关联;校正后的hr (95% CI)分别为1.93(1.29-2.90)、1.78(1.19-2.64)和1.73(1.15-2.60)。结论:不同定义的腹泻患病率从9-39%不等。WHO和ESICM均基于频率,不同于BSCS和基于体重的标准。考虑到ICU患者准确频率计数的困难,基于一致性或权重的定义可能为临床实践和研究提供更实用的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Classifying diarrhea in critically ill patients through various criteria: a cohort study.

Background: The absence of consensus criteria for diarrhea in critically ill patients poses challenges, including an uncertain prevalence and inconsistent findings regarding the impact of diarrhea on mortality. This study aimed to examine the prevalence of diarrhea, the agreement among different diagnostic criteria, and their association with mortality.

Methods: A single-center cohort study was conducted among consecutive adult patients admitted to the intensive care unit (ICU) for at least three days between January 2017 and December 2018. The six diarrhea criteria evaluated were based on frequency, quantity, and consistency. These included the European Society of Intensive Care Medicine (ESICM) criteria (≥ 3 times and > 200 g/day loose or liquid stool), the World Health Organization (WHO) criteria (≥ 3 times loose or liquid stool), the Bristol Stool Chart Scale (BSCS) score of 6 or 7, and other quantity- or frequency-based definitions. Outcomes included: (1) prevalence of diarrhea according to each definition, (2) agreement between criteria, and (3) association between diarrhea and in-hospital mortality. Associations were assessed using multivariable Cox proportional hazards models, yielding hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Among 700 participants, 61% were men; the median age was 71 years. The prevalence of diarrhea ranged from 9 to 39%, depending on the criteria used. The WHO and ESICM criteria showed similar prevalences (18.7% and 15.1%, respectively) and high agreement (Kappa 0.87). However, both had weak agreement with the BSCS criteria (prevalence 39.3%; Kappa 0.52 and 0.43, respectively). In univariable analyses, the presence of diarrhea was associated with in-hospital mortality, regardless of the criteria used. In multivariable analyses, only the > 400 g/day loose or liquid stool, > 200 g/day loose or liquid stool, and BSCS criteria maintained this association; the adjusted HRs (95% CI) were 1.93 (1.29‒2.90), 1.78 (1.19‒2.64), and 1.73 (1.15‒2.60), respectively.

Conclusions: Diarrhea prevalence varied from 9-39% across definitions. WHO and ESICM, both frequency‑based, differed from BSCS and weight‑based criteria. Given the difficulty of accurate frequency counting in ICU patients, consistency‑ or weight‑based definitions may offer a more practical alternative for both clinical practice and research.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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