RT Journal
A1 Sailhamer EA, Carson K, Chang Y, et al
T1 Fulminant clostridium difficile colitis: Patterns of care and predictors of mortality
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD May 18
VO 144
IS 5
SP 433
OP 439
DO 10.1001/archsurg.2009.51
UL http://dx.doi.org/10.1001/archsurg.2009.51
AB 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, ≥35 000/μL or <4000/μL) or bandemia (neutrophil bands, ≥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.