Tirlapur Nikhil, Puthucheary Zudin A, Cooper Jackie A, Sanders Julie, Coen Pietro G, Moonesinghe S Ramani, Wilson A Peter, Mythen Michael G, Montgomery Hugh E
Section of Anaesthetics, Pain Medicine &Intensive Care, Faculty of Medicine, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
Critical Care, University College London Hospitals NHS Foundation Trust, London, UK.
Sci Rep. 2016 Apr 20;6:24691. doi: 10.1038/srep24691.
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.
腹泻在重症监护病房（ICU）患者中很常见，据报道患病率为15%-38%。许多因素可能导致腹泻，包括艰难梭菌、药物（如泻药、抗生素）和肠内营养。腹泻影响患者尊严，增加护理工作量和医疗成本，并通过皮肤损伤、肠内吸收受损及随后的液体失衡加重发病率。我们分析了一组连续入住综合性重症监护病房的9331例患者，以确定ICU患者腹泻的患病率及其与感染病因和临床结局的关系。我们提供的证据表明，腹泻在危重症患者中很常见（患病率为12.9%（1207/9331）），与ICU住院时间延长独立相关（平均（标准误）14.8（0.26）天对3.2（0.09）天，p<0.001）以及死亡率（22.0%（265/1207）对8.7%（705/8124），p<0.001；调整后的风险比为1.99（95%CI 1.70-2.32），p<0.001），即使在调整潜在混杂因素后，与无腹泻患者相比也是如此，且很少由感染病因引起（112/1207（9.2%）），如艰难梭菌（97/1048（9.3%）检测）或病毒学原因（9/172（5.7%）检测）。我们的研究结果表明，ICU中腹泻的非感染性原因占主导，危重症患者腹泻的病理生理学值得进一步研究。
