Diarrhea during critical illness: a multicenter cohort study

doi:10.1007/s00134-022-06663-8

Diarrhea during critical illness: a multicenter cohort study

Pharmacy Practice and Science

Research output: Contribution to journal › Article › peer-review

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Abstract

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 language	English
Pages (from-to)	570-579
Number of pages	10
Journal	Intensive Care Medicine
Volume	48
Issue number	5
DOIs	https://doi.org/10.1007/s00134-022-06663-8
State	Published - 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.

Keywords

Critical illness
Diarrhea
Enteral nutrition
Incidence
Predictors

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00134-022-06663-8

Cite this

@article{f8cf6212e98148e889f9eb148606fa40,

title = "Diarrhea during critical illness: a multicenter cohort study",

abstract = "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.",

keywords = "Critical illness, Diarrhea, Enteral nutrition, Incidence, Predictors",

author = "Dionne, {Joanna C.} and Lawrence Mbuagbaw and Devlin, {John W.} and Duprey, {Matthew S.} and Rodrigo Cartin-Ceba and Jennifer Tsang and Kristen Sullivan and John Muscedere and Mohammed Alshahrani and Wojciech Szczeklik and Paul Lysecki and Alyson Takaoka and Brenda Reeve and Tracy Campbell and Karolina Borowska and Wojciech Serednicki and Robert Cirone and Waleed Alhazzani and Paul Moayyedi and David Armstrong and Lehana Thabane and Roman Jaeschke and Cindy Hamielec and Tim Karachi and Cook, {Deborah J.} and J. Tsang and Dimitra Fleming and Susan O{\textquoteright}Farrell and Brittany Young and Allison Brown and Helen Su and Robin Owen and Kathryn Lalonde and Kathleen Willis and P. Lysecki and T. Campbell and D. Cook and K. Sullivan and A. Takaoka and R. Cirone and K. Kavikondala and C. Hamielec and K. Sullivan and T. Karachi and K. Sullivan and J. Devlin and M. Duprey and R. Cartin-Ceba and H. Raza and B. Nokes",

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{\textquoteright}s Healthcare Hamilton: D Cook (Lead), K Sullivan, A Takaoka. St. Joseph{\textquoteright}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: {\textcopyright} 2022, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = may,

day = "1",

doi = "10.1007/s00134-022-06663-8",

language = "English",

volume = "48",

pages = "570--579",

number = "5",

}

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 - 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.

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

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Diarrhea during critical illness: a multicenter cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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