Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile
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Type
Journal Article
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.
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.
Date Issued
2016-04-20
Date Acceptance
2016-03-31
Citation
Scientific Reports, 2016, 6
ISSN
2045-2322
Publisher
Nature Publishing Group
Journal / Book Title
Scientific Reports
Volume
6
Copyright Statement
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Publication Status
Published
Article Number
24691