Risk Factors and Predictive Model of Diarrhea Among Patients with Severe Stroke

Xiang, Yanling; Li, Feng; Peng, Jiangtao; Qin, Deyu; Yuan, Meizhen; Liu, Guangwei

doi:10.1016/j.wneu.2019.12.125

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…The only disadvantage was the increased frequency or altered characteristics when defining the diarrhea, probably affecting the incidence of diarrhea and factors for this illness. Xiang et al 14 collected data on diarrhea in patients who had experienced a severe stroke and reported that the National Institutes of Health (NIH) Stroke Scale score on admission, Glasgow Coma Scale score on admission, antibiotic use, duration of gavage feeding, and period of stay before the onset of diarrhea independently predicted diarrhea in patients who had experienced a severe stroke. They did not target the population receiving EN for further analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The only disadvantage was the increased frequency or altered characteristics when defining the diarrhea, probably affecting the incidence of diarrhea and factors for this illness. Xiang et al14 collected data on T A B L E 1 (Continued) Abbreviations: Beta coeff., beta coefficient; SE, standard error.F I G U R E 1 ROC curves of the intensive care unit enteral nutrition diarrhea risk prediction model (derivation cohort). ROC, receiver operating characteristic.…”

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confidence: 99%

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Development and validation of a predictive model for diarrhea in ICU patients with enteral nutrition

Chen

Wang

et al. 2023

J Parenter Enteral Nutr

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Background: The aim of this study was to build and validate a risk prediction model for diarrhea in patients in the intensive care unit (ICU) receiving enteral nutrition (EN) by identifying risk factors for diarrhea in these patients. Methods:The risk factors for diarrhea were analyzed to build a prediction model for EN diarrhea in patients in the ICU based on the data collected from 302 patients receiving EN in the ICU. Subsequently, the model was validated by the area under the curve.Results: In this study, the collected data were divided into two groups: a derivation cohort and a validation cohort. The results showed that 54.03% (114) of patients had diarrhea in the derivation cohort and 56.04% (51) of patients had diarrhea in the validation cohort. Moreover, days of EN, high urea nitrogen levels, probiotics, respiratory system disease, and daily doses of nutrient solution were included as predictive factors for diarrhea in patients receiving EN in the ICU. The predictive power of the model was 0.81 (95% CI, 0.752~0.868) in the derivation cohort and 0.736 (95% CI, 0.634~0.837) in the validation cohort. Conclusion:In accordance with the predictive factors, the model, characterized by excellent discrimination and high accuracy, can be used to clinically identify patients in the ICU with a high risk of EN diarrhea.

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Section: Discussionmentioning

confidence: 99%

“…The only disadvantage was the increased frequency or altered characteristics when defining the diarrhea, probably affecting the incidence of diarrhea and factors for this illness. Xiang et al14 collected data on T A B L E 1 (Continued) Abbreviations: Beta coeff., beta coefficient; SE, standard error.F I G U R E 1 ROC curves of the intensive care unit enteral nutrition diarrhea risk prediction model (derivation cohort). ROC, receiver operating characteristic.…”

mentioning

confidence: 99%

Development and validation of a predictive model for diarrhea in ICU patients with enteral nutrition

Chen

Wang

et al. 2023

J Parenter Enteral Nutr

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“…In our experience, antibiotic-associated diarrhoea has particularly significant effects on frail patients, such as those requiring intensive care [ 19 , 20 ]. In an intensive care setting, the antibiotics’ impact on the microbiota is amplified by the effects of vasopressor use, highly processed enteral nutrition products, gastrointestinal tract surgery, age, PPI use, and long-term opiate use [ 19 – 21 ]. Interestingly, in a subset of healthy volunteers treated with antibiotics, the reduction in microbial diversity was similar to that seen in patients in the intensive care unit [ 17 , 18 ].…”

Section: Short-term Negative Health Impact Of Antibiotic Treatment: A...mentioning

confidence: 99%

Can the Evidence-Based Use of Probiotics (Notably Saccharomyces boulardii CNCM I-745 and Lactobacillus rhamnosus GG) Mitigate the Clinical Effects of Antibiotic-Associated Dysbiosis?

Waitzberg,

Guarner,

Hojsak

et al. 2024

Adv Ther

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Dysbiosis corresponds to the disruption of a formerly stable, functionally complete microbiota. In the gut, this imbalance can lead to adverse health outcomes in both the short and long terms, with a potential increase in the lifetime risks of various noncommunicable diseases and disorders such as atopy (like asthma), inflammatory bowel disease, neurological disorders, and even behavioural and psychological disorders. Although antibiotics are highly effective in reducing morbidity and mortality in infectious diseases, antibiotic-associated diarrhoea is a common, non-negligible clinical sign of gut dysbiosis (and the only visible one). Re-establishment of a normal (functional) gut microbiota is promoted by completion of the clinically indicated course of antibiotics, the removal of any other perturbing external factors, the passage of time (i.e. recovery through the microbiota’s natural resilience), appropriate nutritional support, and—in selected cases—the addition of probiotics. Systematic reviews and meta-analyses of clinical trials have confirmed the strain-specific efficacy of some probiotics (notably the yeast Saccharomyces boulardii CNCM I-745 and the bacterium Lactobacillus rhamnosus GG) in the treatment and/or prevention of antibiotic-associated diarrhoea in children and in adults. Unusually for a probiotic, S. boulardii is a eukaryote and is not therefore directly affected by antibiotics—making it suitable for administration in cases of antibiotic-associated diarrhoea. A robust body of evidence from clinical trials and meta-analyses shows that the timely administration of an adequately dosed probiotic (upon initiation of antibiotic treatment or within 48 h) can help to prevent or resolve the consequences of antibiotic-associated dysbiosis (such as diarrhoea) and promote the resilience of the gut microbiota and a return to the pre-antibiotic state. A focus on the prescription of evidence-based, adequately dosed probiotics should help to limit unjustified and potentially ineffective self-medication.

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“…Pneumonia increases the activity of the sympathetic nervous system [ 96 ]. In altered nervous system activities in stroke patients and pre-clinical models, there is impaired gut function, dysbiosis, and diarrhea [ 97 , 98 ]. Whether SARS-CoV-2 induces gut injury through these and other mechanisms remain to be elucidated.…”

Section: Mechanisms Underlying Covid-19 Induced Gi Tract Injurymentioning

confidence: 99%

COVID-19 and Gut Injury

et al. 2022

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COVID-19 induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently a pandemic and it has led to more than 620 million patients with 6.56 million deaths globally. Males are more susceptible to COVID-19 infection and associated with a higher chance to develop severe COVID-19 than females. Aged people are at a high risk of COVID-19 infection, while young children have also increased cases. COVID-19 patients typically develop respiratory system pathologies, however symptoms in the gastrointestinal (GI) tract are also very common. Inflammatory cell recruitments and their secreted cytokines are found in the GI tract in COVID-19 patients. Microbiota changes are the key feature in COVID-19 patients with gut injury. Here, we review all current known mechanisms of COVID-19-induced gut injury, and the most acceptable one is that SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) receptor on host cells in the GI tract. Interestingly, inflammatory bowel disease (IBD) is an inflammatory disorder, but the patients with IBD do not have the increased risk to develop COVID-19. There is currently no cure for COVID-19, but anti-viruses and monoclonal antibodies reduce viral load and shorten the recovery time of the disease. We summarize current therapeutics that target symptoms in the GI tract, including probiotics, ACE2 inhibitors and nutrients. These are promising therapeutic options for COVID-19-induced gut injury.

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Risk Factors and Predictive Model of Diarrhea Among Patients with Severe Stroke

Cited by 8 publications

References 29 publications

Development and validation of a predictive model for diarrhea in ICU patients with enteral nutrition

Development and validation of a predictive model for diarrhea in ICU patients with enteral nutrition

Can the Evidence-Based Use of Probiotics (Notably Saccharomyces boulardii CNCM I-745 and Lactobacillus rhamnosus GG) Mitigate the Clinical Effects of Antibiotic-Associated Dysbiosis?

COVID-19 and Gut Injury

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