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Peer-reviewedCC BYJournal of Intensive Care

Laxative use after cardiac arrest: exposure timing, treatment selection, and outcome interpretation

  • Jian Sun1
  • Peihong Li1
  • Hongyi Hu1
  1. 1Department of Gastroenterology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine
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Abstract

We commend Duan et al. for examining laxative use after cardiac arrest. However, because follow-up began at return of spontaneous circulation, whereas exposure timing was not reported, the observed association may reflect both immortal time and treatment selection: patients who survived and recovered sufficiently may have been more likely to receive laxatives. A time-varying exposure defined by first administration, with landmark analysis as a sensitivity analysis, would better align treatment and risk time. The reported time-varying-effect model does not estimate the effect of initiating treatment on a particular day and, therefore, cannot support a 15-day treatment window. The findings should be framed as observational associations rather than evidence that laxatives improve survival.

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Cite

BibTeXRIS
BibTeX
@article{sun2026laxative,
  title = {{Laxative use after cardiac arrest: exposure timing, treatment selection, and outcome interpretation}},
  author = {Jian Sun and Peihong Li and Hongyi Hu},
  journal = {Journal of Intensive Care},
  year = {2026},
  month = oct,
  doi = {10.1186/s40560-026-00950-y},
  url = {https://doi.org/10.1186/s40560-026-00950-y},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Laxative use after cardiac arrest: exposure timing, treatment selection, and outcome interpretation
AU  - Jian Sun
AU  - Peihong Li
AU  - Hongyi Hu
PY  - 2026
DA  - 2026/10/25
JO  - Journal of Intensive Care
DO  - 10.1186/s40560-026-00950-y
UR  - https://doi.org/10.1186/s40560-026-00950-y
AB  - We commend Duan et al. for examining laxative use after cardiac arrest. However, because follow-up began at return of spontaneous circulation, whereas exposure timing was not reported, the observed association may reflect both immortal time and treatment selection: patients who survived and recovered sufficiently may have been more likely to receive laxatives. A time-varying exposure defined by first administration, with landmark analysis as a sensitivity analysis, would better align treatment and risk time. The reported time-varying-effect model does not estimate the effect of initiating treatment on a particular day and, therefore, cannot support a 15-day treatment window. The findings should be framed as observational associations rather than evidence that laxatives improve survival.
SN  - 2052-0492
ER  -