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- Title
Clinical Predictors of Fulminant Colitis in Patients with Clostridium difficile Infection.
- Authors
Girotra, Mohit; Kumar, Vivek; Khan, Javaid M.; Damisse, Pamela; Abraham, Rtika R.; Aggarwal, Vikas; Dutta, Sudhir K.
- Abstract
Background/Aim: Clostridium difficile infection (CDI) can affect up to 8% of hospitalized patients. Twentyfive percent CDI patients may develop C. difficile associated diarrhea (CDAD) and 1-3% may progress to fulminant C. difficile colitis (FCDC). Once developed, FCDC has higher rates of complications and mortality. Patients and Methods: A 10-year retrospective review of FCDC patients who underwent colectomy was performed and compared with randomly selected age- and sex-matched non-fulminant CDAD patients at our institution. FCDC (n=18) and CDAD (n=49) groups were defined clinically, radiologically, and pathologically. Univariate analysis was performed using Chi-square and Student's t test followed by multivariate logistic regression to compute independent predictors. Results: FCDC patients were significantly older (77 ± 13 years), presented with triad of abdominal pain (89%), diarrhea (72%), and distention (39%); 28% had prior CDI and had greater hemodynamic instability. In contrast, CDAD patients were comparatively younger (65 ± 20 years), presented with only 1 or 2 of these 3 symptoms and only 5% had prior CDI. No significant difference was noted between the 2 groups in terms of comorbid conditions, use of antibiotics, or proton pump inhibitor. Leukocytosis was significantly higher in FCDC patients (18.6 ± 15.8/mm3 vs 10.7 ± 5.2/mm3; P=0.04) and further increased until the point of surgery. Use of antiperistaltic medications was higher in FCDC than CDAD group (56% vs 22%; P=0.01). Conclusions: Our data suggest several clinical and laboratory features in CDI patients, which may be indicative of FCDC. These include old age (>70 years), prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis (>18,000/mm3), hemodynamic instability, and use of antiperistaltic medications.
- Subjects
MARYLAND; COLITIS; AGE distribution; BLOOD testing; CHI-squared test; CLOSTRIDIUM diseases; DIAGNOSTIC imaging; DIARRHEA; MEDICAL records; MORTALITY; MULTIVARIATE analysis; PAIN; T-test (Statistics); LOGISTIC regression analysis; RETROSPECTIVE studies; SEVERITY of illness index; DESCRIPTIVE statistics; DISEASE risk factors
- Publication
Saudi Journal of Gastroenterology, 2012, Vol 18, Issue 2, p133
- ISSN
1319-3767
- Publication type
Article
- DOI
10.4103/1319-3767.93820