C. difficile colitis--predictors of fatal outcome.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Haig DudukgianAndreas M Kaiser

Abstract

Clostridium difficile colitis (CDC) has a clinical spectrum ranging from mild diarrhea to fulminant, potentially fatal colitis. The pathophysiology for this variation remains poorly understood. A total abdominal colectomy may be lifesaving if performed before the point of no return. Identification of negative prognostic factors is desperately needed for optimization of the clinical and operative management. In-patients with CDC between 1999 and 2006 were identified through the discharge database (ICD-9: 008.45). Of these, patients with positive ELISA toxin or biopsy were included. Excluded were ELISA-negative patients. Data collected included general demographics, underlying medical conditions, APACHE II score, clinical and laboratory data, and duration of the medical treatment. Mortality and cure were the two endpoints. Regression analysis was used to identify parameters associated with mortality. Three hundred ninety-eight patients (mean age 59, range 19-94) with CDC were analyzed. Fourteen patients (3.52%) underwent surgery. Mortality in the cohort was 10.3% (41/398 patients). Patients with fatal outcome had a longer pre-CDC hospital stay (11 vs. 6 days). Mortality was significantly (p<0.05) associated with a higher APACHE I...Continue Reading

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