Diarrhea and patient outcomes in the intensive care unit: Systematic review and meta-analysis

Taito, Shunsuke; Kawai, Yusuke; Liu, Keibun; Ariie, Takashi; Tsujimoto, Yasushi; Banno, Masahiro; Kataoka, Yuki

doi:10.1016/j.jcrc.2019.06.014

Cited by 18 publications

(28 citation statements)

References 22 publications

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“…Patients with diarrhea have higher severity scores than those without diarrhea [2,6,[8][9][10]14]. In our study, most patients received treatments that could cause diarrhea, such as enteral nutrition and antimicrobials.…”

Section: Discussionmentioning

confidence: 93%

“…Previous studies have reported an association between the presence of diarrhea and mortality; however, no studies have examined whether mortality increases with a greater quantity of diarrhea [14,42]. A systematic review of 12 studies, most of which used the de nition of diarrhea as three or more loose or liquid stools, showed an association between diarrhea and mortality (RR: 1.43; 95% CI: 1.03-1.98; I 2 = 86.7%; n = 11,866) [14]. We focused on the quantity of diarrhea in this study and showed that mortality increased with increasing quantity of diarrhea according to the adjusted RR in patients with newly developed diarrhea in the ICU.…”

Section: Discussionmentioning

confidence: 98%

“…Possible explanations for the relationship between diarrhea and mortality are as follows. First, diarrhea can be a sign of gastrointestinal organ failure that is associated with a high risk of mortality [4,14,43].…”

Section: Discussionmentioning

confidence: 99%

“…The median age of patients was 72 (IQR [64, 80]) years, 158/231 (68.4%) patients were men, median CCI was two (IQR [1,3]), median APACHE II score was 21 (IQR [14,28]), and median SOFA score was 9 (IQR [6,12]). Patients admitted for nonoperative reasons were the most prevalent (162/231, 70.1%).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Several studies have shown an association between diarrhea and mortality [6][7][8][9][10][11][12][13][14], and this association remained even in ICU patients without CDI [8]. Taito et al conducted a systematic review and demonstrated that diarrhea was associated with the length of hospital stay and ICU mortality [14]; however, all previous studies de ned diarrhea based on dichotomized criteria with respect to consistency and frequency. The European Society of Intensive Care Medicine (ESICM) has adopted dichotomized criteria for the quantity of diarrhea as a component of the de nition of diarrhea in the ICU [3].…”

Section: Introductionmentioning

confidence: 99%

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Association between diarrhea quantity and in-hospital mortality in intensive care unit patients: A retrospective cohort study

Yamamoto

Yamazaki

Yamamoto

et al. 2021

Preprint

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Background Previous studies have shown that diarrhea is associated with increased mortality of patients in intensive care units (ICUs). However, these studies used dichotomized cutoff values, even if diarrhea was a continuous condition. This study aimed to assess the association between diarrhea quantity and mortality in ICU patients with newly developed diarrhea. Methods We conducted this single-center retrospective cohort study at the Kameda Medical Center ICU. We consecutively included all adult ICU patients with newly developed diarrhea in the ICU between January 2017 and December 2018. Newly developed diarrhea was defined based on a Bristol stool chart scale ≥ 6 and frequency of diarrhea ≥ 3 times per day. We excluded patients who already had diarrhea on the day of ICU admission among other criteria. We collected data on the quantity of diarrhea on the day when patients newly developed diarrhea. The primary outcome was in-hospital mortality. The risk ratio (RR) and 95% confidence interval (CI) for the association between the quantity of diarrhea and mortality were estimated using multivariable-modified Poisson regression models adjusted for the Charlson Comorbidity Index, sequential organ failure assessment score, and serum albumin levels. Results Among 231 participants, 68.4% (158/231) were men; the median age of the patients was 72 years. The median quantity of diarrhea was 401 g (interquartile range [IQR] 230‒645 g), and in-hospital mortality was 22.9% (53/231). More diarrhea at baseline was associated with higher in-hospital mortality; the unadjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.19). This association remained in the multivariable-adjusted analysis; the adjusted RR (95% CI) per 200-g increase was 1.10 (1.01‒1.20). Conclusions A greater quantity of diarrhea was an independent risk factor for in-hospital mortality. The quantity of diarrhea may be an indicator of disease severity in ICU patients.

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Section: Discussionmentioning

confidence: 93%