Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE
Year : 2012  |  Volume : 18  |  Issue : 2  |  Page : 133-139

Clinical predictors of fulminant colitis in patients with Clostridium difficile infection


1 Division of Gastroenterology, Department of Medicine, The Johns Hopkins University/Sinai Hospital, Baltimore, USA
2 Division of Gastroenterology, Department of Medicine, Norwalk Hospital Program/Yale University, Norwalk, CT, USA
3 Department of Medicine, Johns Hopkins University/Sinai Hospital, Baltimore, MD, USA
4 Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
5 Department of Medicine, University of Maryland School of Medicine, Baltimore and Division Director of Gastroenterology, Sinai Hospital of Baltimore, USA

Correspondence Address:
Sudhir K Dutta
Professor of Medicine, University of Maryland School of Medicine and Division Chief, Gastroenterology, Sinai Hospital of Baltimore, 2411 W. Belvedere Ave, Baltimore, MD, 21215
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.93820

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Background/Aim: 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. 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/mm 3 vs 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). 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/mm 3 ), hemodynamic instability, and use of antiperistaltic medications.


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