Faculty Collaboration Database

Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality. Arch Surg 2009 May;144(5):433-9; discussion 439-40

Date

05/20/2009

Pubmed ID

19451485

DOI

10.1001/archsurg.2009.51

Scopus ID

2-s2.0-66249121680 (requires institutional sign-in at Scopus site)   199 Citations

Abstract

HYPOTHESIS: There exist predictors of mortality and the need for colectomy among patients with fulminant Clostridium difficile colitis.

DESIGN: Retrospective study.

SETTING: Academic tertiary referral center.

PATIENTS: We reviewed the records of 4796 inpatients diagnosed as having C difficile colitis from January 1, 1996, to December 31, 2007, and identified 199 (4.1%) with fulminant C difficile colitis, as defined by the need for colectomy or admission to the intensive care unit for C difficile colitis.

MAIN OUTCOME MEASURES: Risk of inpatient mortality was determined by multivariate analysis according to clinical predictors, colectomy, and medical team.

RESULTS: The inhospital mortality rate for fulminant C difficile colitis was 34.7%. Independent predictors of mortality included the following: (1) age of 70 years or older, (2) severe leukocytosis or leukopenia (white blood cell count, >or=35 000/microL or <4000/microL) or bandemia (neutrophil bands, >or=10%), and (3) cardiorespiratory failure (intubation or vasopressors). When all 3 factors were present, the mortality rate was 57.1%; when all 3 were absent, the mortality rate was 0%. Patients who underwent colectomy had a trend toward decreased mortality rates (odds ratio, 0.49; 95% confidence interval, 0.21-1.1; P = .08). Among patients admitted primarily for fulminant C difficile colitis, care in the surgical department compared with the nonsurgical department resulted in a higher rate of operation (85.1% vs 11.2%; P < .001) and lower mortality rates (12.8% vs 39.3%; P = .001). Patients admitted directly to the surgical department had a shorter mean (SD) interval from admission to operation (0 vs 1.7 [2.8] days; P = .001).

CONCLUSIONS: Despite awareness and treatment, fulminant C difficile colitis remains a highly lethal disease. Reliable predictors of mortality exist and should be used to prompt aggressive surgical intervention. Survival rates are higher in patients who were cared for by surgical vs nonsurgical departments, possibly because of more frequent and earlier operations.

Author List

Sailhamer EA, Carson K, Chang Y, Zacharias N, Spaniolas K, Tabbara M, Alam HB, DeMoya MA, Velmahos GC

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Clostridium Infections
Colectomy
Enterocolitis, Pseudomembranous
Female
Heart Failure
Hospital Mortality
Humans
Intensive Care Units
Leukocytosis
Leukopenia
Male
Massachusetts
Multivariate Analysis
Predictive Value of Tests
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome