Clinical predictors of fulminant colitis in patients with clostridium difficile infection
Saudi Journal of Gastroenterology [The]. 2012; 18 (2): 133-139
en Inglés
| IMEMR
| ID: emr-118277
ABSTRACT
Clostridium difficile infection [CDI] can affect up to 8% of hospitalized patients. Twenty-five 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. 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 [m=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. 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/mm[3]us 10.7 +/- 5.2/mm[3], 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]. 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/mm[3]], hemodynamic instability, and use of antiperistaltic medications
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Índice:
IMEMR (Mediterraneo Oriental)
Asunto principal:
Enterocolitis Seudomembranosa
/
Valor Predictivo de las Pruebas
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Estudios Retrospectivos
/
Factores de Edad
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Colectomía
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Infecciones por Corynebacterium
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Leucocitosis
Límite:
Anciano
/
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Saudi J. Gastroenterol.
Año:
2012
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