Risk Factors of Acute Gastrointestinal Failure in Critically Ill Patients With Traumatic Brain Injury

Fu, Weijun; Shi, Nengxian; Wan, Yahui; Mei, Fen; Qiu, Binghui; Bao, Yun; Zhang, Yu; Hao, Jingwen; Jiang, He; Peng, Xiaojie

doi:10.1097/scs.0000000000006130

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…In our study, the presence of healthcare-related infections did not seem to correlate with FI persistence at discharge from the neurorehabilitation program. The published literature shows correlations between pulmonary infections and acute gastrointestinal failure (AGF) [42], probably due to a compromised mucosal immune system being common to both [43]. Another interesting aspect of AGF seems to be its correlation with frontal damage, which correlates with the persistence of FI at discharge from neurorehabilitation, according to our data [44].…”

Section: Discussionsupporting

confidence: 64%

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Pelizzari,

Antoniono,

Giraudo

et al. 2023

Neurology International

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Background: In this study, we aimed to investigate the incidence of fecal incontinence (FI) after severe acquired brain injuries (sABIs) and to determine whether this symptom can lead to an inability to return home after rehabilitation. Methods: This was a retrospective observational cohort study. In total, 521 acute sABI inpatients were enrolled from the Department of Neurorehabilitation at an academic tertiary care hospital. Patients were divided into two groups, with and without FI, at the end of the rehabilitation phase. The primary and secondary endpoints were the incidence of persistent FI and any difference in the discharge destination. Results: Upon admission, new-onset FI was found in 443 (85%) patients, of which 38% had traumatic sABI. Moreover, 62.7% of all patients had FI upon admission. At discharge, 53.3% (264/495) of patients still had FI. Of these, 75.4% (199/264) had a Rancho Level of Cognitive Functioning Scale (LCFS) ≥3. A statistically significant correlation between FI at discharge and the presence of frontal lesions, autonomic crises, and increased LCFS scores was noted. Among the patients discharged to their homes, the proportion with persistent FI was lower (34% vs. 53.3). Conclusions: FI was significantly persistent after sABI, even after recovery from unconsciousness, and must be considered as a consequence of, rather than an independent risk factor for, unfavorable outcomes.

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Section: Discussionsupporting

confidence: 64%

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Pelizzari,

Antoniono,

Giraudo

et al. 2023

Neurology International

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“…Generally, comas can be classified by GCS: severe, with GCS[? ]8, moderate, GCS 9-12, and minor, GCS >13 [37] . Low GCS was a mortality risk factor and may have been predictive of the poor prognosis of MDRE-NM in our study.…”

Section: Discussionmentioning

confidence: 98%

Molecular epidemiology and survival analysis of nosocomial meningitis induced by multi-drug resistance Enterobacteriaceae

Zheng¹,

Cao²,

Qian³

et al. 2020

Preprint

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Objectives: To evaluate the molecular epidemiology and mortality risk factors of nosocomial meningitis (NM) induced by multi-drug resistance Enterobacteriaceae (MDRE) in China. Methods: We performed a multi-center study of MDRE NM patients in 2 neurosurgical centers in China from 2014 to 2019. Molecular and phenotype microbiology epidemiology of each MDRE were reviewed and tested, and 21 clinical variables on mortality risk factors were extracted and evaluated by multivariate Cox analysis for NM. Results: In total, 90 MDRE NM patients were included in this study. Klebsiella (K.) pneumoniae occupied the highest proportion (51.11%, 46/90), 44 (44.44%) were meropenem-resistant, ceftriaxone resistance in target MDRE was relatively high (92.22%, 83/90), blaKPC (67.50%, 27/40) was the predominant carbapenem resistance gene, and blaCTX-M-1, blaTEM and blaCTM-M-9 were the three most popular extended spectrum β-lactamases (ESBLs) producing genes of the MDRE. Multivariate Cox analysis showed that external ventricular drainage (EVD, odds ratio (OR) 2.524, 95% confidence interval (CI) 1.101-5.787, P = 0.029) and Glasgow Coma Scale (GCS) ≤8 (OR 4.033, 95% CI 1.526-10.645, P = 0.005) were mortality risk factors of MDRE NM. Conclusions: NM caused by MDRE is an important sign of the failure of neurosurgery, and MDRE has multiple drug resistance genotypes, and EVD and GCS≤8 are independent mortality risk factors of MDRE NM, which deserves the attention of microbiologist and neurosurgical clinicians.

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“…As for TBI patients, the excessive loss of magnesium from the digestive tract may be a cause of the hypomagnesemia after TBI. As a common non-neurological complication after TBI, gastrointestinal dysfunction has been investigated, developing in 95% of TBI patients hospitalized in the intensive care unit [ 24 , 25 , 26 ]. Additionally, the excessive loss from the kidney by the massive use of diuretics mannitol and furosemide, which are commonly prescribed among TBI patients to reduce intracranial pressure, is another cause of the hypomagnesemia.…”

Section: Discussionmentioning

confidence: 99%

Hypomagnesemia Is Associated with the Acute Kidney Injury in Traumatic Brain Injury Patients: A Pilot Study

Liu

Wang

et al. 2023

Brain Sciences

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Background: Acute kidney injury (AKI) commonly develops among traumatic brain injury (TBI) patients and causes poorer outcomes. We perform this study to explore the relationship between serum magnesium and the risk of AKI among TBI. Methods: TBI patients recorded in the Medical Information Mart for Intensive Care-III database were eligible for this research. The restricted cubic spline (RCS) was utilized to fit the correlation between serum magnesium level and the AKI. Univariate and subsequent multivariate logistic regression analysis were utilized to explore risk factors of AKI and confirmed the correlation between serum magnesium and AKI. Results: The incidence of AKI in included TBI was 21.0%. The RCS showed that the correlation between magnesium level and risk of AKI was U-shaped. Compared with patients whose magnesium level was between 1.5 and 2.0 mg/dL, those with a magnesium level of <1.5 mg/dL or >2.0 mg/dL had a higher incidence of AKI. Multivariate logistic regression confirmed age, chronic renal disease, ISS, serum creatinine, vasopressor, mechanical ventilation, and serum magnesium <1.5 mg/dL were independently related with the AKI in TBI. Conclusion: Abnormal low serum magnesium level is correlated with AKI development in TBI patients. Physicians should pay attention on renal function of TBI patients especially those with hypomagnesemia.

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Risk Factors of Acute Gastrointestinal Failure in Critically Ill Patients With Traumatic Brain Injury

Cited by 7 publications

References 20 publications

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Molecular epidemiology and survival analysis of nosocomial meningitis induced by multi-drug resistance Enterobacteriaceae

Hypomagnesemia Is Associated with the Acute Kidney Injury in Traumatic Brain Injury Patients: A Pilot Study

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