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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 survival curves 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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f3: Kaplan-Meier survival curves 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: The relationship between diarrhoea and mortality was analysed by modelling data as time to death using a Cox proportional hazard model with diarrhoea as a time-dependent covariate (Fig. 3). The hazard ratio of mortality for admission with vs without diarrhoea was 1.99 (95% CI 1.70–2.32, p < 0.001). Higher ICU mortality was observed for older patients, those with a medical referral, and increasing APACHE II score. Patients admitted to ICU due to operative intervention had significantly lower ICU mortality compared to all other causes (Table 4).


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 survival curves 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

f3: Kaplan-Meier survival curves 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: The relationship between diarrhoea and mortality was analysed by modelling data as time to death using a Cox proportional hazard model with diarrhoea as a time-dependent covariate (Fig. 3). The hazard ratio of mortality for admission with vs without diarrhoea was 1.99 (95% CI 1.70–2.32, p < 0.001). Higher ICU mortality was observed for older patients, those with a medical referral, and increasing APACHE II score. Patients admitted to ICU due to operative intervention had significantly lower ICU mortality compared to all other causes (Table 4).

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