Diarrhea during critical illness: a multicenter cohort study

Joanna C Dionne; Lawrence Mbuagbaw; John W Devlin; Matthew S Duprey; Rodrigo Cartin-Ceba; Jennifer Tsang; Kristen Sullivan; John Muscedere; Mohammed Alshahrani; Wojciech Szczeklik; Paul Lysecki; Alyson Takaoka; Brenda Reeve; Tracy Campbell; Karolina Borowska; Wojciech Serednicki; Robert Cirone; Waleed Alhazzani; Paul Moayyedi; David Armstrong; Lehana Thabane; Roman Jaeschke; Cindy Hamielec; Tim Karachi; Deborah J Cook; DICE Investigators

doi:10.1007/s00134-022-06663-8

Diarrhea during critical illness: a multicenter cohort study

Intensive Care Med. 2022 May;48(5):570-579. doi: 10.1007/s00134-022-06663-8. Epub 2022 Apr 11.

Authors

Joanna C Dionne^{1

2

3}, Lawrence Mbuagbaw^{4

5}, John W Devlin⁶, Matthew S Duprey⁷, Rodrigo Cartin-Ceba⁸, Jennifer Tsang^{9

10}, Kristen Sullivan⁹, John Muscedere¹¹, Mohammed Alshahrani¹², Wojciech Szczeklik¹³, Paul Lysecki¹⁴, Alyson Takaoka⁴, Brenda Reeve¹⁵, Tracy Campbell¹⁴, Karolina Borowska¹³, Wojciech Serednicki¹³, Robert Cirone¹⁶, Waleed Alhazzani^{9

4}, Paul Moayyedi^{9

4

17}, David Armstrong^{9

17}, Lehana Thabane^{4

5}, Roman Jaeschke^{9

4}, Cindy Hamielec⁹, Tim Karachi⁹, Deborah J Cook^{9

4}; DICE Investigators

Collaborators

DICE Investigators:
J Tsang, Dimitra Fleming, Susan O'Farrell, Brittany Young, Allison Brown, Helen Su, Robin Owen, Kathryn Lalonde, Kathleen Willis, P Lysecki, T Campbell, D Cook, K Sullivan, A Takaoka, R Cirone, K Kavikondala, C Hamielec, K Sullivan, T Karachi, K Sullivan, J Devlin, M Duprey, R Cartin-Ceba, H Raza, B Nokes, J Muscedere, M Hunt, I Georgescu, A Alshahrani, L P Asonto, B Reeve, W Dechert, W Szczeklik, K Borowska

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, ON, Canada. dionnejc@mcmaster.ca.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. dionnejc@mcmaster.ca.
³ Hamilton Health Sciences Juravinski Hospital and Cancer Centre, 711 Concession Street, A3-75, Hamilton, ON, L8V 1C3, Canada. dionnejc@mcmaster.ca.
⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁵ Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada.
⁶ School of Pharmacy, Northeastern University, Boston, MA, USA.
⁷ School of Public Health, Brown University, Providence, RI, USA.
⁸ Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA.
⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹⁰ Niagara Health System, Saint Catharines, ON, Canada.
¹¹ Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
¹² Emergency and Critical Care Department, King Fahad Hospital of the University Imam Abdul Rahman ben Faisal university Dammam, Dammam, Saudi Arabia.
¹³ Jagiellonian University Medical College, Kraków, Poland.
¹⁴ Joseph Brant Hospital, Burlington, ON, Canada.
¹⁵ Brantford General Hospital, Brantford, ON, Canada.
¹⁶ St. Joseph's Health Centre, Toronto, ON, Canada.
¹⁷ Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.

PMID: 35411491
DOI: 10.1007/s00134-022-06663-8

Abstract

Purpose: To study the incidence, predictors, and outcomes of diarrhea during the stay in the intensive care unit (ICU).

Methods: Prospective cohort of consecutive adults in the ICU for > 24 h during a 10-week period across 12 intensive care units (ICUs) internationally. The explored outcomes were: (1) incidence of diarrhea, (2) Clostridioides difficile-associated diarrhea (CDAD); (3) ICU and hospital length of stay (LOS) and mortality in patients with diarrhea. We fit generalized linear models to evaluate the predictors, management, morbidity and mortality associated with diarrhea.

Results: Among 1109 patients aged 61.4 (17.5) [mean (standard deviation)] years, 981(88.5%) were medical and 645 (58.2%) were mechanically ventilated. The incidence was 73.8% (818 patients, 73.8%, 95% confidence interval [CI] 71.1-76.6) using the definition of the World Health Organisation (WHO). Incidence varied across definitions (Bristol 53.5%, 95% CI 50.4-56.7; Bliss 37.7%, 95% CI 34.9-40.4). Of 99 patients with diarrhea undergoing CDAD testing, 23 tested positive (2.2% incidence, 95% CI 1.5-3.4). Independent predictors included enteral nutrition (RR 1.23, 95% CI 1.16-1.31, p < 0.001), antibiotic days (RR 1.02, 95% CI 1.02-1.03, p < 0.001), and suppositories (RR 1.14 95% CI 1.06-1.22, p < 0.001). Opiates decreased diarrhea risk (RR 0.76, 95% CI 0.68-0.86, p < 0.001). Diarrhea prompted management modifications (altered enteral nutrition or medications: RR 10.25, 95% CI 5.14-20.45, p < 0.001) or other consequences (fecal management device or CDAD testing: RR 6.16, 95% CI 3.4-11.17, p < 0.001). Diarrhea was associated with a longer time to discharge for ICU or hospital stay, but was not associated with hospital mortality.

Conclusion: Diarrhea is common, has several predictors, and prompts changes in patient care, is associated with longer time to discharge but not mortality.

Keywords: Critical illness; Diarrhea; Enteral nutrition; Incidence; Predictors.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Critical Illness* / epidemiology
Critical Illness* / therapy
Diarrhea / epidemiology
Enteral Nutrition
Humans
Intensive Care Units*
Length of Stay
Prospective Studies