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Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile.

Tirlapur N, Puthucheary ZA, Cooper JA, Sanders J, Coen PG, Moonesinghe SR, Wilson AP, Mythen MG, Montgomery HE - Sci Rep (2016)

Bottom Line: Many factors may cause diarrhoea, including Clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds.Diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance.We provide evidence that diarrhoea is common (12.9% (1207/9331) prevalence) in critically ill patients, independently associated with increased intensive care unit length of stay (mean (standard error) 14.8 (0.26) vs 3.2 (0.09) days, p < 0.001) and mortality (22.0% (265/1207) vs 8.7% (705/8124), p < 0.001; adjusted hazard ratio 1.99 (95% CI 1.70-2.32), p < 0.001) compared to patients without diarrhoea even after adjusting for potential confounding factors, and infrequently caused by infective aetiology (112/1207 (9.2%)) such as Clostridium difficile (97/1048 (9.3%) tested) or virological causes (9/172 (5.7%) tested).

View Article: PubMed Central - PubMed

Affiliation: Section of Anaesthetics, Pain Medicine &Intensive Care, Faculty of Medicine, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.

ABSTRACT
Diarrhoea is common in Intensive Care Unit (ICU) patients, with a reported prevalence of 15-38%. Many factors may cause diarrhoea, including Clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds. Diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance. We analysed a cohort of 9331 consecutive patients admitted to a mixed general intensive care unit to establish the prevalence of diarrhoea in intensive care unit patients, and its relationship with infective aetiology and clinical outcomes. We provide evidence that diarrhoea is common (12.9% (1207/9331) prevalence) in critically ill patients, independently associated with increased intensive care unit length of stay (mean (standard error) 14.8 (0.26) vs 3.2 (0.09) days, p < 0.001) and mortality (22.0% (265/1207) vs 8.7% (705/8124), p < 0.001; adjusted hazard ratio 1.99 (95% CI 1.70-2.32), p < 0.001) compared to patients without diarrhoea even after adjusting for potential confounding factors, and infrequently caused by infective aetiology (112/1207 (9.2%)) such as Clostridium difficile (97/1048 (9.3%) tested) or virological causes (9/172 (5.7%) tested). Our findings suggest non-infective causes of diarrhoea in ICU predominate and pathophysiology of diarrhoea in critically ill patients warrants further investigation.

No MeSH data available.


Related in: MedlinePlus

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f1: Flow chart of patient enrolment.

Mentions: Between 01/01/2006 and 31/12/2010, 7697 patients with 9331 admissions meeting the inclusion criteria were admitted to University College Hospital (UCH) ICU (mean age ± standard deviation (SD) 58.6 ± 17.7 years, 55.0% male, 66.9% from surgical admissions, median (interquartile range (IQR)) Acute Physiology and Chronic Health Evaluation (APACHE) II score 16 (11–22)). Diarrhoea affected the patient in 1207 (12.9%) of these admissions (Fig. 1). The demographics for the study group are shown in Table 1. The relationship between diarrhoea and type of surgery (gastrointestinal vs non-gastrointestinal) is shown in Supplementary Table S1. The prevalence of diarrhoea in ICU re-admissions was 23.1% (178/772), compared to 13.3% (85/637) in re-admitted patients on their first admission and 11.9% (946/7922) of patients with only one ICU admission.


Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile.

Tirlapur N, Puthucheary ZA, Cooper JA, Sanders J, Coen PG, Moonesinghe SR, Wilson AP, Mythen MG, Montgomery HE - Sci Rep (2016)

Flow chart of patient enrolment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837391&req=5

f1: Flow chart of patient enrolment.
Mentions: Between 01/01/2006 and 31/12/2010, 7697 patients with 9331 admissions meeting the inclusion criteria were admitted to University College Hospital (UCH) ICU (mean age ± standard deviation (SD) 58.6 ± 17.7 years, 55.0% male, 66.9% from surgical admissions, median (interquartile range (IQR)) Acute Physiology and Chronic Health Evaluation (APACHE) II score 16 (11–22)). Diarrhoea affected the patient in 1207 (12.9%) of these admissions (Fig. 1). The demographics for the study group are shown in Table 1. The relationship between diarrhoea and type of surgery (gastrointestinal vs non-gastrointestinal) is shown in Supplementary Table S1. The prevalence of diarrhoea in ICU re-admissions was 23.1% (178/772), compared to 13.3% (85/637) in re-admitted patients on their first admission and 11.9% (946/7922) of patients with only one ICU admission.

Bottom Line: Many factors may cause diarrhoea, including Clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds.Diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance.We provide evidence that diarrhoea is common (12.9% (1207/9331) prevalence) in critically ill patients, independently associated with increased intensive care unit length of stay (mean (standard error) 14.8 (0.26) vs 3.2 (0.09) days, p < 0.001) and mortality (22.0% (265/1207) vs 8.7% (705/8124), p < 0.001; adjusted hazard ratio 1.99 (95% CI 1.70-2.32), p < 0.001) compared to patients without diarrhoea even after adjusting for potential confounding factors, and infrequently caused by infective aetiology (112/1207 (9.2%)) such as Clostridium difficile (97/1048 (9.3%) tested) or virological causes (9/172 (5.7%) tested).

View Article: PubMed Central - PubMed

Affiliation: Section of Anaesthetics, Pain Medicine &Intensive Care, Faculty of Medicine, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.

ABSTRACT
Diarrhoea is common in Intensive Care Unit (ICU) patients, with a reported prevalence of 15-38%. Many factors may cause diarrhoea, including Clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds. Diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance. We analysed a cohort of 9331 consecutive patients admitted to a mixed general intensive care unit to establish the prevalence of diarrhoea in intensive care unit patients, and its relationship with infective aetiology and clinical outcomes. We provide evidence that diarrhoea is common (12.9% (1207/9331) prevalence) in critically ill patients, independently associated with increased intensive care unit length of stay (mean (standard error) 14.8 (0.26) vs 3.2 (0.09) days, p < 0.001) and mortality (22.0% (265/1207) vs 8.7% (705/8124), p < 0.001; adjusted hazard ratio 1.99 (95% CI 1.70-2.32), p < 0.001) compared to patients without diarrhoea even after adjusting for potential confounding factors, and infrequently caused by infective aetiology (112/1207 (9.2%)) such as Clostridium difficile (97/1048 (9.3%) tested) or virological causes (9/172 (5.7%) tested). Our findings suggest non-infective causes of diarrhoea in ICU predominate and pathophysiology of diarrhoea in critically ill patients warrants further investigation.

No MeSH data available.


Related in: MedlinePlus