title: Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease.
abstract: BACKGROUND
  The increasing incidence of Clostridium difficile (C. difficile) infection (CDI) among patients with inflammatory bowel disease is well recognised. However, most studies have focused on demonstrating that CDI is associated with adverse outcomes in IBD patients. Few have attempted to identify predictors of severe outcomes associated with CDI among IBD patients.
  
  
  OBJECTIVE
  To identify clinical and laboratory factors that predict severe outcomes associated with CDI in IBD patients.
  
  
  METHODS
  From a multi-institution EMR database, we identified all hospitalised patients with at least one diagnosis code for C. difficile from among those with a diagnosis of Crohn's disease or ulcerative colitis. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Cox proportional hazards models were used to identify predictors of the primary outcome from among demographic, disease-related, laboratory and medication variables.
  
  
  RESULTS
  A total of 294 patients with CDI-IBD were included in our study. Of these, 58 patients (20%) met our primary outcome (45 deaths, 13 colectomy) at a median of 31 days. On multivariate analysis, serum albumin <3 g/dL (HR 5.75, 95% CI 1.34-24.56), haemoglobin below 9 g/dL (HR 5.29, 95% CI 1.58-17.69) and creatinine above 1.5 mg/dL (HR 1.98, 95% CI 1.04-3.79) were independent predictors of our primary outcome. Examining laboratory parameters as continuous variables or shortening our primary outcome to include events within 90 days yielded similar results.
  
  
  CONCLUSIONS
  Serum albumin below 3 g/dL, haemoglobin below 9 g/dL and serum creatinine above 1.5 mg/dL were independent predictors of severe outcomes in hospitalised IBD patients with Clostridium difficile infection.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA. aananthakrishnan@partners.org
authors.forename: A N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.forename: R
authors.initials: R
authors.lastname: Guzman-Perez
authors.forename: V
authors.initials: V
authors.lastname: Gainer
authors.forename: T
authors.initials: T
authors.lastname: Cai
authors.forename: S
authors.initials: S
authors.lastname: Churchill
authors.forename: I
authors.initials: I
authors.lastname: Kohane
authors.forename: R M
authors.initials: RM
authors.lastname: Plenge
authors.forename: S
authors.initials: S
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy; D003404:Creatinine / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin; D003404:Creatinine