Diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to Clostridium difficile.
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.
Section of Anaesthetics, Pain Medicine &Intensive Care, Faculty of Medicine, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
Nikhil
N
Tirlapur
Critical Care, University College London Hospitals NHS Foundation Trust, London, UK.|Institute for Sport Exercise and Health, University College London, London, UK.|Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore.
Zudin A
ZA
Puthucheary
Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK.
Jackie A
JA
Cooper
St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Julie
J
Sanders
Infection Control Office, University College London Hospitals NHS Foundation Trust, London, UK.
Pietro G
PG
Coen
University College London Hospitals NHS Foundation Trust/University College London National Institute for Health Research Surgical Outcomes Research Centre, London, UK.
S Ramani
SR
Moonesinghe
Microbiology &Virology, University College London Hospitals NHS Foundation Trust, London, UK.
A Peter
AP
Wilson
University College London Hospitals NHS Foundation Trust/University College London National Institute for Health Research Biomedical Research Centre, London, UK.
Michael G
MG
Mythen
Institute for Sport Exercise and Health, University College London, London, UK.|Critical Care, Whittington Hospital, University College London, London, UK.
Hugh E
HE
Montgomery
D000328:Adult; D000368:Aged; D016360:Clostridioides difficile; D016638:Critical Illness; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index