Diarrhea during critical illness: a multicenter cohort study

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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.

Original languageEnglish
Pages (from-to)570-579
Number of pages10
JournalIntensive Care Medicine
Issue number5
StatePublished - May 1 2022

Bibliographical note

Funding Information:
We appreciate the data management assistance of Suzanne Duchesne and Nicole Zytaruk for this study. We also thank the research teams at each participating institution. A special tribute is dedicated to Wojciech Serednicki, co-author, who recently passed away. DICE Investigators: Niagara Health System: J Tsang (Lead), Dimitra (Gina) Fleming, Susan O'Farrell, Brittany Young, Allison Brown, Helen Su, Robin Owen, Kathryn Lalonde, Kathleen Willis. Joseph Brant Hospital: P Lysecki (Lead), T Campbell. St. Joseph’s Healthcare Hamilton: D Cook (Lead), K Sullivan, A Takaoka. St. Joseph’s Hospital Toronto: R Cirone (Lead), K Kavikondala. Hamilton Health Sciences (General Site): C Hamielec (Lead), K Sullivan. Hamilton Health Sciences (Juravinski Site): T Karachi (Lead), K Sullivan. Northeastern University, Boston: J Devlin (Lead), M Duprey. Mayo Clinic, Phoenix: R Cartin-Ceba (Lead), H Raza, B Nokes. Kingston General Hospital: J Muscedere (Lead), M Hunt, I Georgescu. University of Dammam, A Alshahrani (Lead), LP Asonto. Brantford General Hospital, B Reeve (Lead), W Dechert. Jagellonian University Medical School, W Szczeklik (Lead), K Borowska.

Funding Information:
Peer-review grants from the Hamilton Regional Medical Associates, Hamilton Health Sciences Department of Medicine, Physicians Services Incorporated of Ontario, and the Canadian Association of Gastroenterology. Career Awards were from Physicians Services Incorporated of Ontario (J Dionne) and the Canadian Institutes for Health Research (D Cook).

Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Critical illness
  • Diarrhea
  • Enteral nutrition
  • Incidence
  • Predictors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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