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

Murali, M; Ly, C; Tirlapur, N; Montgomery, HE; Cooper, JA; Wilson, AP; (2019) Diarrhoea in critical care is rarely infective in origin, associated with increased length of stay and higher mortality. Journal of the Intensive Care Society 10.1177/1751143719843423. (In press). Green open access

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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.

Type: Article
Title: Diarrhoea in critical care is rarely infective in origin, associated with increased length of stay and higher mortality
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1751143719843423
Publisher version: https://doi.org/10.1177/1751143719843423
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Critical care, diarrhoea, laxatives, Clostridium difficile, length of stay, mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10075113
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