PURPOSE: C difficile associated pancolitis is an increasing nosocomial infection asociated with antibiotic use. The purpose of the study was to examine the clinical findings associated with fulminant disease and identify predictors of mortality.
METHODS: We performed a retrospective chart review of 37 consecutive patients identified to have c.difficile associated pancolitis in the year 2005 at a University Medical Center. Patient demographics, co-morbid illness, physiologic, laboratory and clnical data were recorded. Univariate and multivariate regression analysis was performed to identify markers for the presence of fulminant disease and identify which factors are predictors of mortality.
RESULTS: Eighteen patients (49%) developed fulminant pancolitis. These patients had a higher prevalence of renal disease 33.3% compared to 10.5% in the less severe cases. They had a higher incidence of tachycardia (26.3% vs. 77.8%) and a higher incidence of hypotension (26.3% vs 77.8%). Significant lab abnormalities included higher numbers of inmature WBC (9.9% vs 2.0%) and lower albumin levels (1.9 +/− 0.5 vs. 2.6 +/− 0.6).The prevalence of fulminant disease was associated with 3 factors by stepwise multiple logistic regression analysis (p<0.05): history of renal disease, presence of tachycardia and presence of hypotension. Univariate predictors of presence of fulminant pancolitis (p<0.05)included the presence of tachypnea, percentage of inmature white blood cells, and albumin values. By stepwise multiple logistic regression, predictors of mortality (P<0.05) included a history of COPD, a history of renal disease and the presence of hypotension. Higher percentage of inmature WBC and lower mean albumin values were also significant univariate predictors of mortality (p<0.05).
CONCLUSION: A history of renal disease, hypotension and tachycardia on presentation are associated with development of fulminant disease in patients with c.difficle pancolitis. Those with a history of COPD, renal disease and hypotension on presentation have a higher mortality. Higher percentage of inmature WBC and low serum albumin are markers of fulminant disease as well as increased mortality.
CLINICAL IMPLICATIONS: Identifying risk factors for the development of fulminant c.difficle pancolitis may allow earlier aggressive interventions to improve mortality.
DISCLOSURE: Francis Castiller, None.