The association between defecation frequency and mortality in critically ill patients with suspected sepsis in Israel.

Abstract

Background: The pivotal role of the gastrointestinal (GI) tract in sepsis is well recognized. This study aimed to evaluate the associations between defecation frequency as a basic assessment of GI function and the clinical outcomes of intensive care unit (ICU) patients with suspected sepsis.

Methods: This retrospective, single-center study included patients suspected of having sepsis. The number of defecations and consecutive days without defecation during the 72 hours preceding the suspected infection were assessed. The primary outcome was 30-day all-cause mortality. Multivariate regression analysis adjusting for potential confounders was employed to establish the associations between GI function and clinical outcomes.

Results: The final analysis included 1,306 patients with a median age of 56.2 years (interquartile range [IQR], 39.6-69.1); 919 (70.4%) were male, and the median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 22.0 (IQR, 17.0-27.0). The median Sequential Organ Failure Assessment (SOFA) score at the time of suspected infection was 5.0 (IQR, 3.0-7.0). Mortality rates were 20.3%, 28.0%, and 34.3% for patients with 0-2, 3-5, and >5 defecations, respectively (P<0.001). There was a strong correlation between the number of defecations and mortality (r=0.7, P=0.01). In multivariate analyses, each defecation was independently associated with increased mortality (adjusted odds ratio [aOR], 1.07; 95% CI, 1.01-1.12; P=0.01), while each consecutive day without a defecation was associated with reduced mortality (aOR, 0.83; 95% CI, 0.73-0.96; P=0.01).

Conclusions: A higher number of defecations in the 72 hours preceding suspected sepsis is associated with increased 30-day all-cause mortality, suggesting a potential association with GI tract dysfunction.