Diarrhea and patient outcomes in the intensive care unit: Systematic review and meta-analysis

Shunsuke Taito; Yusuke Kawai; Keibun Liu; Takashi Ariie; Yasushi Tsujimoto; Masahiro Banno; Yuki Kataoka

doi:10.1016/j.jcrc.2019.06.014

Diarrhea and patient outcomes in the intensive care unit: Systematic review and meta-analysis

J Crit Care. 2019 Oct:53:142-148. doi: 10.1016/j.jcrc.2019.06.014. Epub 2019 Jun 18.

Authors

Shunsuke Taito¹, Yusuke Kawai², Keibun Liu³, Takashi Ariie⁴, Yasushi Tsujimoto⁵, Masahiro Banno⁶, Yuki Kataoka⁷

Affiliations

¹ Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan. Electronic address: shutaitou@hiroshima-u.ac.jp.
² Department of Nursing, Fujita Health University Hospital, Aichi, Japan.
³ Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Gunma, Japan.
⁴ Department of Rehabilitation, Takagi Hospital, Fukuoka, Japan.
⁵ Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Nephrology and Dialysis, Kyoritsu Hospital, Hyogo, Japan.
⁶ Department of Psychiatry, Seichiryo Hospital, Aichi, Japan; Department of Psychiatry, Nagoya University Graduate School of Medicine, Aichi, Japan.
⁷ Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan; Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.

PMID: 31238230
DOI: 10.1016/j.jcrc.2019.06.014

Abstract

Purpose: We aimed to determine whether diarrhea experienced by patients in the intensive care unit (ICU) is related to their clinical outcomes.

Material and methods: We performed a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and the World Health Organization International Clinical Trials Registry Platform between inception and August 2018. The primary outcome was ICU mortality, and secondary outcomes included hospital mortality, ICU length of stay, hospital length of stay. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: Twelve studies (enrolling 13,140 patients) compared patients with diarrhea to patients without diarrhea in the ICU. Diarrhea was related to ICU mortality (relative risk [RR]: 1.43; 95% confidence interval [CI]: 1.03 to 1.98). The mean difference (MD) in ICU length of stay between patients with and without diarrhea was 8.08 days (95% CI: 5.85 to 10.32), while the MD in hospital length of stay was 9.67 (95% CI: 2.17 to 17.16). The certainty of evidence for these outcomes was low.

Conclusions: The diarrhea experienced by patients may be associated with higher mortality and prolonged length of stay in the ICU and hospital.

Keywords: Diarrhea; Intensive care unit; Length of stay; Meta-analysis; Mortality; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Critical Illness / mortality*
Diarrhea / complications*
Diarrhea / mortality
Hospital Mortality
Humans
Intensive Care Units*
Length of Stay / statistics & numerical data*
Outcome Assessment, Health Care