Diarrhoea in critical care is rarely infective in origin, associated with increased length of stay and higher mortality

Mayur Murali; Clare Ly; Nikhil Tirlapur; Hugh E Montgomery; Jackie A Cooper; A Peter Wilson

doi:10.1177/1751143719843423

Diarrhoea in critical care is rarely infective in origin, associated with increased length of stay and higher mortality

J Intensive Care Soc. 2020 Feb;21(1):72-78. doi: 10.1177/1751143719843423. Epub 2019 May 7.

Authors

Mayur Murali¹, Clare Ly², Nikhil Tirlapur³, Hugh E Montgomery⁴, Jackie A Cooper⁵, A Peter Wilson⁶

Affiliations

¹ Anaesthetic Department, Whittington Hospital, London, UK.
² Department of Intensive Care, Whittington Hospital, London, UK.
³ Section of Anaesthetics, Pain Medicine & Intensive Care, Faculty of Medicine, Imperial College London, London, UK.
⁴ Centre for Human Health and Performance, University College London, London, UK.
⁵ Institute of Cardiovascular Science, University College London, London, UK.
⁶ Department of Microbiology & Virology, University College London Hospitals, London, UK.

Abstract

Diarrhoea, defined as > 3 loose or liquid stools per day, affects 9.7-41% of intensive care unit patients, negatively impacting on patient dignity, intensifying nursing workload and increasing morbidity. Its pathogenesis is poorly understood, but infective agents, intensive care unit therapies (such as enteral feed) and critical illness changes in the gut microbiome are thought to play a role. We analysed a consecutive cohort of 3737 patients admitted to a mixed general intensive care unit. Diarrhoea prevalence was lower than previously reported (5.3%), rarely infective in origin (6.5%) and associated with increased length of stay (median (inter-quartile range) 2.3 (1.0-5.0) days vs. 10 days (5.0-22.0), p < 0.001, sub-distribution hazard ratio 0.55 (95% CI 0.48-0.63), p < 0.001) and mortality (9.5% vs. 18.1%, p = 0.005, sub-distribution hazard ratio 1.20 (95% CI 0.79-1.81), p = 0.40), compared to patients without diarrhoea. In addition, 17.1% of patients received laxatives <24 h prior to diarrhoea onset. Further research on diarrhoea's pathogenesis in critical care is required; robust treatment protocols, investigation rationalisation and improved laxative prescribing may reduce its incidence and improve related outcomes.

Keywords: Clostridium difficile; Critical care; diarrhoea; laxatives; length of stay; mortality.