title: Leukemoid reactions complicating colitis due to Clostridium difficile.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Wright State University School of Medicine, Dayton, OH, USA. mmarinella@pol.net
authors.forename: Mark A
authors.initials: MA
authors.lastname: Marinella
authors.forename: Steven D
authors.initials: SD
authors.lastname: Burdette
authors.forename: Roger
authors.initials: R
authors.lastname: Bedimo
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Markert
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents