Clinical predictors of fulminant colitis in patients with Clostridium difficile infection

Saudi Journal of Gastroenterology, 04/04/2012

The data suggest several clinical and laboratory features in clostridium difficile infection (CDI) patients, which may be indicative of FCDC. These include old age, prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis, hemodynamic instability, and use of antiperistaltic medications.

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 the 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).

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