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

Producción científica: Article › revisión exhaustiva

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Resumen

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.

Idioma original	English
Páginas (desde-hasta)	570-579
Número de páginas	10
Publicación	Intensive Care Medicine
Volumen	48
N.º	5
DOI	https://doi.org/10.1007/s00134-022-06663-8
Estado	Published - may 1 2022

Nota bibliográfica

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

Financiación

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\u2019s Healthcare Hamilton: D Cook (Lead), K Sullivan, A Takaoka. St. Joseph\u2019s 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. 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).

Financiadores
Brittany Young, Allison Brown
Hamilton Health Sciences Department of Medicine, Physicians Services Incorporated of Ontario
Jagellonian University Medical School
Canadian Association of Gastroenterology
Northeastern University, China
University of Dammam

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Good health and well being

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1007/s00134-022-06663-8

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@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 = "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",

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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.

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 - https://www.scopus.com/pages/publications/85128335329

UR - https://www.scopus.com/pages/publications/85128335329#tab=citedBy

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 -

Diarrhea during critical illness: a multicenter cohort study

Resumen

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Financiación

ODS de las Naciones Unidas

ASJC Scopus subject areas

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