Kawai Yasuyuki, Miyazaki Keita, Osaki Toru, Yamamoto Koji, Tsuruta Keisuke, Asai Hideki, Fukushima Hidetada
Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Resusc Plus. 2025 Mar 26;23:100946. doi: 10.1016/j.resplu.2025.100946. eCollection 2025 May.
To evaluate the association between large watery stools-a potential early sign of non-occlusive mesenteric ischaemia-and neurological outcomes.
We retrospectively analysed data from 495 adult patients with out-of-hospital cardiac arrest admitted to our tertiary centre between April 2015 and March 2024. Individuals who achieved return of spontaneous circulation but remained comatose after resuscitation were included. Large watery stools were defined as ≥300 mL of watery/loose stools occurring at least twice within 24 h after admission. We performed stepwise logistic regression analysis to identify predictors available at admission and assess the relationship between watery stool occurrence and neurological outcomes.
Overall, 161 (32%) patients developed large watery stools within 24 h. Patients with watery stools experienced significantly higher rates of unfavourable neurological outcomes at discharge (favourable in 9% vs. 21% in patients without watery stools). Stepwise logistic regression analysis identified six independent predictors of large watery stools-lactate, low-flow interval, C-reactive protein, activated partial thromboplastin time, noradrenaline use, and creatinine-reflecting disturbances in metabolic status, perfusion, coagulation, and inflammatory responses. The final model demonstrated an ROC_AUC of 0.72 (95% CI [0.68-0.73]). After calibration, the Brier score improved from 0.21 (95% CI [0.20-0.23]) to 0.19 (95% CI [0.17-0.21]).
After out-of-hospital cardiac arrest, early-onset large watery stools is strongly associated with poor neurological outcomes, potentially serving as a clinical indicator of intestinal ischaemia and systemic inflammation. Incorporating coagulation and metabolic markers into predictive models may facilitate early identification of high-risk patients, aiding timely diagnosis and intervention.
评估大量水样便（非闭塞性肠系膜缺血的一种潜在早期迹象）与神经学预后之间的关联。
我们回顾性分析了2015年4月至2024年3月期间入住我们三级中心的495例院外心脏骤停成年患者的数据。纳入了实现自主循环恢复但复苏后仍昏迷的个体。大量水样便定义为入院后24小时内至少出现两次≥300毫升的水样/稀便。我们进行逐步逻辑回归分析，以确定入院时可用的预测因素，并评估水样便发生与神经学预后之间的关系。
总体而言，161例（32%）患者在24小时内出现大量水样便。有水样便的患者出院时神经学不良预后的发生率显著更高（9%，无水样便患者为21%）。逐步逻辑回归分析确定了大量水样便的六个独立预测因素——乳酸、低流量间隔、C反应蛋白、活化部分凝血活酶时间、去甲肾上腺素使用和肌酐，反映代谢状态、灌注、凝血和炎症反应的紊乱。最终模型的ROC_AUC为0.72（95%CI[0.68 - 0.73]）。校准后，Brier评分从0.21（95%CI[0.20 - 0.23]）提高到0.19（95%CI[0.17 - 0.21]）。
院外心脏骤停后，早期出现的大量水样便与不良神经学预后密切相关，可能作为肠道缺血和全身炎症的临床指标。将凝血和代谢标志物纳入预测模型可能有助于早期识别高危患者，有助于及时诊断和干预。
