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- Title
Diarrhea during critical illness: a multicenter cohort study.
- Authors
Dionne, Joanna C.; Mbuagbaw, Lawrence; Devlin, John W.; Duprey, Matthew S.; Cartin-Ceba, Rodrigo; Tsang, Jennifer; Sullivan, Kristen; Muscedere, John; Alshahrani, Mohammed; Szczeklik, Wojciech; Lysecki, Paul; Takaoka, Alyson; Reeve, Brenda; Campbell, Tracy; Borowska, Karolina; Serednicki, Wojciech; Cirone, Robert; Alhazzani, Waleed; Moayyedi, Paul; Armstrong, David
- 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.
- Subjects
WORLD Health Organization; CRITICALLY ill; ORAL rehydration therapy; DIARRHEA; INTENSIVE care units; LENGTH of stay in hospitals; COHORT analysis
- Publication
Intensive Care Medicine, 2022, Vol 48, Issue 5, p570
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-022-06663-8