title: Clinical predictors of fulminant colitis in patients with Clostridium difficile infection.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine/Sinai Hospital, Baltimore 21215, USA.
authors.forename: Mohit
authors.initials: M
authors.lastname: Girotra
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumar
authors.forename: Javaid M
authors.initials: JM
authors.lastname: Khan
authors.forename: Pamela
authors.initials: P
authors.lastname: Damisse
authors.forename: Rtika R
authors.initials: RR
authors.lastname: Abraham
authors.forename: Vikas
authors.initials: V
authors.lastname: Aggarwal
authors.forename: Sudhir K
authors.initials: SK
authors.lastname: Dutta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003092:Colitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D015897:Comorbidity; D003967:Diarrhea / Q000382:microbiology; D018450:Disease Progression; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies