Abstract Background Despite advances in post-cardiac arrest (CA) care, mortality rates remain high. Intestinal dysfunction following CA is associated with adverse clinical outcomes. While laxatives might be a potential therapeutic strategy for restoring intestinal function, there is currently a lack of evidence. Objective This study aims to explore the safety and efficacy of laxatives as therapeutic agents for intestinal function recovery in CA, while further assessing the most suitable types of laxatives for this clinical context. Methods Utilizing the MIMIC-IV database, we conducted a retrospective cohort study categorizing patients into laxative and non-laxative groups. Propensity score matching (PSM) was applied to balance baseline characteristics. We classified confounders into prehospital and hospitalization categories, establishing three hierarchical adjustment models. Through multivariable Cox and logistic regression analyses, we assessed 30-day and extended mortality risks while evaluating laxative-associated safety outcomes. Time-dependent Cox regression analysis was utilized to assess the time-varying effect of laxative administration. Furthermore, we also comparatively analyzed the risk–benefit profiles of commonly used laxatives. Results 2604 patients were eligible for this study. After PSM, a total of 898 patients were average divided into two groups. Patients in the laxative group demonstrated a statistically significant reduction in 30-day mortality risk compared to the non-laxative group (HR = 0.686, 95%CI 0.550–0.855, P = 0.001). After applying time-dependent Cox regression analysis, the results remain consistent (HR = − 0.771 + 0.632 × lnday + 1, 95%CI 0.528–0.835, P = 0.001). Meanwhile, laxative did not increase the risk of sepsis and Clostridium difficile infection but improved the bowel sounds recovery and increased the ICU-free day. Further subgroup analysis revealed that the use of docusate sodium (HR = 0.753, 95%CI 0.566–1.000, P = 0.050) may be associated with a decreased mortality risk. Conclusion Early using laxative to improve intestinal function is associated with improved survival outcomes. However, clinical application may be guided by the bowel sounds recovery and demonstrated tolerance to enteral feeding. This still requires further studies to confirm.
Duan et al. (Mon,) studied this question.