TY - JOUR
T1 - Diarrhea during critical illness
T2 - a multicenter cohort study
AU - Dionne, Joanna C.
AU - Mbuagbaw, Lawrence
AU - Devlin, John W.
AU - Duprey, Matthew S.
AU - Cartin-Ceba, Rodrigo
AU - Tsang, Jennifer
AU - Sullivan, Kristen
AU - Muscedere, John
AU - Alshahrani, Mohammed
AU - Szczeklik, Wojciech
AU - Lysecki, Paul
AU - Takaoka, Alyson
AU - Reeve, Brenda
AU - Campbell, Tracy
AU - Borowska, Karolina
AU - Serednicki, Wojciech
AU - Cirone, Robert
AU - Alhazzani, Waleed
AU - Moayyedi, Paul
AU - Armstrong, David
AU - Thabane, Lehana
AU - Jaeschke, Roman
AU - Hamielec, Cindy
AU - Karachi, Tim
AU - Cook, Deborah J.
AU - Tsang, J.
AU - Fleming, Dimitra
AU - O’Farrell, Susan
AU - Young, Brittany
AU - Brown, Allison
AU - Su, Helen
AU - Owen, Robin
AU - Lalonde, Kathryn
AU - Willis, Kathleen
AU - Lysecki, P.
AU - Campbell, T.
AU - Cook, D.
AU - Sullivan, K.
AU - Takaoka, A.
AU - Cirone, R.
AU - Kavikondala, K.
AU - Hamielec, C.
AU - Sullivan, K.
AU - Karachi, T.
AU - Sullivan, K.
AU - Devlin, J.
AU - Duprey, M.
AU - Cartin-Ceba, R.
AU - Raza, H.
AU - Nokes, B.
N1 - Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Purpose: To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU). Methods: Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides difficile-associated diarrhea (CDAD); (3) ICU and hospital length of stay (LOS) and mortality in patients with diarrhea. We fit generalized linear models to evaluate the predictors, management, morbidity and mortality associated with diarrhea. Results: Among 1109 patients aged 61.4 (17.5) [mean (standard deviation)] years, 981(88.5%) were medical and 645 (58.2%) were mechanically ventilated. The incidence was 73.8% (818 patients, 73.8%, 95% confidence interval [CI] 71.1–76.6) using the definition of the World Health Organisation (WHO). Incidence varied across definitions (Bristol 53.5%, 95% CI 50.4–56.7; Bliss 37.7%, 95% CI 34.9–40.4). Of 99 patients with diarrhea undergoing CDAD testing, 23 tested positive (2.2% incidence, 95% CI 1.5–3.4). Independent predictors included enteral nutrition (RR 1.23, 95% CI 1.16–1.31, p < 0.001), antibiotic days (RR 1.02, 95% CI 1.02–1.03, p < 0.001), and suppositories (RR 1.14 95% CI 1.06–1.22, p < 0.001). Opiates decreased diarrhea risk (RR 0.76, 95% CI 0.68–0.86, p < 0.001). Diarrhea prompted management modifications (altered enteral nutrition or medications: RR 10.25, 95% CI 5.14–20.45, p < 0.001) or other consequences (fecal management device or CDAD testing: RR 6.16, 95% CI 3.4–11.17, p < 0.001). Diarrhea was associated with a longer time to discharge for ICU or hospital stay, but was not associated with hospital mortality. Conclusion: Diarrhea is common, has several predictors, and prompts changes in patient care, is associated with longer time to discharge but not mortality.
AB - Purpose: To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU). Methods: Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides difficile-associated diarrhea (CDAD); (3) ICU and hospital length of stay (LOS) and mortality in patients with diarrhea. We fit generalized linear models to evaluate the predictors, management, morbidity and mortality associated with diarrhea. Results: Among 1109 patients aged 61.4 (17.5) [mean (standard deviation)] years, 981(88.5%) were medical and 645 (58.2%) were mechanically ventilated. The incidence was 73.8% (818 patients, 73.8%, 95% confidence interval [CI] 71.1–76.6) using the definition of the World Health Organisation (WHO). Incidence varied across definitions (Bristol 53.5%, 95% CI 50.4–56.7; Bliss 37.7%, 95% CI 34.9–40.4). Of 99 patients with diarrhea undergoing CDAD testing, 23 tested positive (2.2% incidence, 95% CI 1.5–3.4). Independent predictors included enteral nutrition (RR 1.23, 95% CI 1.16–1.31, p < 0.001), antibiotic days (RR 1.02, 95% CI 1.02–1.03, p < 0.001), and suppositories (RR 1.14 95% CI 1.06–1.22, p < 0.001). Opiates decreased diarrhea risk (RR 0.76, 95% CI 0.68–0.86, p < 0.001). Diarrhea prompted management modifications (altered enteral nutrition or medications: RR 10.25, 95% CI 5.14–20.45, p < 0.001) or other consequences (fecal management device or CDAD testing: RR 6.16, 95% CI 3.4–11.17, p < 0.001). Diarrhea was associated with a longer time to discharge for ICU or hospital stay, but was not associated with hospital mortality. Conclusion: Diarrhea is common, has several predictors, and prompts changes in patient care, is associated with longer time to discharge but not mortality.
KW - Critical illness
KW - Diarrhea
KW - Enteral nutrition
KW - Incidence
KW - Predictors
UR - http://www.scopus.com/inward/record.url?scp=85128335329&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85128335329&partnerID=8YFLogxK
U2 - 10.1007/s00134-022-06663-8
DO - 10.1007/s00134-022-06663-8
M3 - Article
C2 - 35411491
AN - SCOPUS:85128335329
SN - 0342-4642
VL - 48
SP - 570
EP - 579
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 5
ER -