Prevalence and Risk Factors of Diarrhoea among Critically Ill Patients in Intensive Care Units: A Cross-sectional Study

Introduction: Diarrhoea is common in critically ill patients that may be caused due to many factors such as Clostridium difficile, drugs (e.g., laxatives, antibiotics) and enteral feeds. The incidence of diarrhoea in the Intensive Care Units (ICU) has ranged in the literature from 2-95%. This wide variation may be due to lack of consistent definitions applied across studies, and ineffective metrics in monitoring patient’s bowel habits in the ICU. Diarrhoea from any cause can place patients at risk for complications such as skin breakdown, dehydration, electrolyte disturbance, renal dysfunction, hypovolaemia, malnutrition, and contamination of wounds; therefore, diarrhoea should be recognised promptly. Aim: To identify the prevalence of diarrhoea, its risk factors and its association with selected variables among patients admitted in ICU for >24 hours. Materials and Methods: The present cross-sectional descriptive study was conducted with the purpose to acquire detailed information on diarrhoea and its associated risk factors in Apollo hospitals in northeastern region, India. The study was conducted for a period of six months (October 2023-March 2024) among ICU patients who stayed for >24 hours in adult ICU of a tertiary care hospital in northeastern region, India. The diarrhoea patients were included in the study as defined by World Gastroenterology Organisation. Patients admitted under Gastroenterology Department, diarrhoea on admission and advised to use laxatives (e.g., hepatic encephalopathy) were excluded from the study. Both descriptive and inferential statistics were used to analyse the study findings. Results: A total of 1219 patients were included in the study, out of which 50 (4.2%) patients were found to have diarrhoea. The age of the patients was found to be >65 years for 32% patients with diarrhoea. Majority (82%) of the patients with diarrhoea passed stool 3-6 times/day, 4% had positive results for C.difficile, 52% of patients stayed in the ICU for >14 days. Antibiotic or antifungal therapy was administered to all patients (100%) and all of them (100%) received empirical antibiotic therapy. A 90% of patients were on ventilator for 0-15 days. This study identified the non-modifiable risk factors including age >65 years {Risk Ratio (RR) 7.5, 95% CI 0.03-0.004}, ventilation (RR 7, 95% CI 0.14 - 0.02) and modifiable risk factor i.e., sepsis (RR 11.6, 95% CI 0.35 - 0.03). In contrast, antibiotic administration was found to have low risk (RR 0.04 95% CI 0.04 - 0) for causing diarrhoea. The study also identified that in critically ill patients, diarrhoea was significantly associated with ventilator use (p<0.01), sepsis (p<0.05), and an ICU stay longer than 14 days (p<0.05). Conclusion: According to the present study findings, diarrhoea is a frequent concern in the ICU and is associated with prolonged mechanical ventilation, increased length of ICU stays, skin breakdown and renal dysfunction. The results showed that 100% samples who had diarrhoea were on antibiotics. Hence further studies will be required to strengthen the use of antibiotics.