Joanna C Dionne1,2,3, Lawrence Mbuagbaw4,5, John W Devlin6, Matthew S Duprey7, Rodrigo Cartin-Ceba8, Jennifer Tsang9,10, Kristen Sullivan9, John Muscedere11, Mohammed Alshahrani12, Wojciech Szczeklik13, Paul Lysecki14, Alyson Takaoka4, Brenda Reeve15, Tracy Campbell14, Karolina Borowska13, Wojciech Serednicki13, Robert Cirone16, Waleed Alhazzani9,4, Paul Moayyedi9,4,17, David Armstrong9,17, Lehana Thabane4,5, Roman Jaeschke9,4, Cindy Hamielec9, Tim Karachi9, Deborah J Cook9,4. 1. Department of Medicine, McMaster University, Hamilton, ON, Canada. dionnejc@mcmaster.ca. 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. dionnejc@mcmaster.ca. 3. Hamilton Health Sciences Juravinski Hospital and Cancer Centre, 711 Concession Street, A3-75, Hamilton, ON, L8V 1C3, Canada. dionnejc@mcmaster.ca. 4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 5. Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada. 6. School of Pharmacy, Northeastern University, Boston, MA, USA. 7. School of Public Health, Brown University, Providence, RI, USA. 8. Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA. 9. Department of Medicine, McMaster University, Hamilton, ON, Canada. 10. Niagara Health System, Saint Catharines, ON, Canada. 11. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 12. Emergency and Critical Care Department, King Fahad Hospital of the University Imam Abdul Rahman ben Faisal university Dammam, Dammam, Saudi Arabia. 13. Jagiellonian University Medical College, Kraków, Poland. 14. Joseph Brant Hospital, Burlington, ON, Canada. 15. Brantford General Hospital, Brantford, ON, Canada. 16. St. Joseph's Health Centre, Toronto, ON, Canada. 17. Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
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.
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.
Authors: Tyler Hay; Adam M Deane; Tom Rechnitzer; Kate Fetterplace; Rebecca Reilly; Melissa Ankravs; Michael Bailey; Timothy Fazio; James Anstey; Rohit D'Costa; Jeffrey J Presneill; Christopher M MacIsaac; Rinaldo Bellomo Journal: J Crit Care Date: 2019-04-08 Impact factor: 3.425