Leukemoid reactions complicating colitis due to Clostridium difficile.
BACKGROUND
We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 10(9)/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions.


METHODS
We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 x 10(9)/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 x 10(9)/L).


RESULTS
The mean peak leukocyte count was 52 +/- 18.2 x 10(9)/L (+/- SD) in the case group and 14.9 +/- 6.5 x 10(9)/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 x 10(9)/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 X 10(9)/L.


CONCLUSIONS
Patients with C difficile colitis and a leukocyte count greater than 35 x 10(9)/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.
Marinella
Mark A
MA
Department of Internal Medicine, Wright State University School of Medicine, Dayton, OH, USA. mmarinella@pol.net
Burdette
Steven D
SD
Bedimo
Roger
R
Markert
Ronald J
RJ
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002423:Cause of Death; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D007955:Leukemoid Reaction / Q000150:complications*; D008297:Male; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents