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.
