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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

Kaplan-Meier estimate of time to discharge for admissions of patients suffering diarrhoea during their intensive care unit stay vs admissions not suffering diarrhoea using a Cox proportional hazards model with diarrhoea as a time dependent co-variate.
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f2: Kaplan-Meier estimate of time to discharge for admissions of patients suffering diarrhoea during their intensive care unit stay vs admissions not suffering diarrhoea using a Cox proportional hazards model with diarrhoea as a time dependent co-variate.

Mentions: We assessed the relationship between ICU LOS and time from ICU admission to diagnosis of diarrhoea using a Cox proportional hazard model with diarrhoea as a time-dependent covariate (Fig. 2). The proportional hazards assumption did not hold as hazard curves crossed at 13 days. Analysis before and after this cut point showed admissions of patients suffering diarrhoea early in their ICU stay (within 13 days) were less likely to be discharged than admissions not suffering diarrhoea (hazard ratio 0.91, 95% CI 0.83–0.99, p = 0.03), but admissions of patients suffering diarrhoea later in their ICU stay (after 13 days) were more likely to be discharged from ICU than those not suffering diarrhoea (hazard ratio 3.15, 95% CI 2.65–3.74, p < 0.001).


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)

Kaplan-Meier estimate of time to discharge for admissions of patients suffering diarrhoea during their intensive care unit stay vs admissions not suffering diarrhoea using a Cox proportional hazards model with diarrhoea as a time dependent co-variate.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2: Kaplan-Meier estimate of time to discharge for admissions of patients suffering diarrhoea during their intensive care unit stay vs admissions not suffering diarrhoea using a Cox proportional hazards model with diarrhoea as a time dependent co-variate.
Mentions: We assessed the relationship between ICU LOS and time from ICU admission to diagnosis of diarrhoea using a Cox proportional hazard model with diarrhoea as a time-dependent covariate (Fig. 2). The proportional hazards assumption did not hold as hazard curves crossed at 13 days. Analysis before and after this cut point showed admissions of patients suffering diarrhoea early in their ICU stay (within 13 days) were less likely to be discharged than admissions not suffering diarrhoea (hazard ratio 0.91, 95% CI 0.83–0.99, p = 0.03), but admissions of patients suffering diarrhoea later in their ICU stay (after 13 days) were more likely to be discharged from ICU than those not suffering diarrhoea (hazard ratio 3.15, 95% CI 2.65–3.74, p < 0.001).

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