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. 2012 Mar-Apr;18(2):133-9.
doi: 10.4103/1319-3767.93820.

Clinical predictors of fulminant colitis in patients with Clostridium difficile infection

Mohit Girotra  1 , Vivek Kumar, Javaid M Khan, Pamela Damisse, Rtika R Abraham, Vikas Aggarwal, Sudhir K Dutta
Affiliations

Clinical predictors of fulminant colitis in patients with Clostridium difficile infection

Mohit Girotra et al. Saudi J Gastroenterol. 2012 Mar-Apr.

Abstract

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/mm³ vs 10.7 ± 5.2/mm³; 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/mm³), hemodynamic instability, and use of antiperistaltic medications.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Barographic comparison of presenting symptoms in fulminant Clostridium difficile colitis (FCDC) and C. difficile associated diarrhea (CDAD) groups. Patients in FCDC group have significantly higher abdominal pain, distention, and diarrhea when compared with CDAD patients. Also, there is a significant history of prior C. difficile infection in FCDC subgroup
Figure 2
Figure 2
Barograph demonstrating the effect of different medications on the development of fulminant Clostridium difficile colitis (FCDC). There is no significant difference between FCDC and C. difficile associated diarrhea groups in terms of antibiotic or proton pump inhibitor use, but a significantly higher use of antiperistaltic medications in FCDC group
Box 1
Box 1
Summary of red flags for development of fulminant Clostridium difficile colitis
See this image and copyright information in PMC

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