Diarrhea during critical illness: a multicenter cohort study

Intensive Care Medicine volume 48, pages 570–579 (2022) Published: 11 April 2022

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.