Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy, and Postoperative Complications: A Population-Based Inception Cohort Study.
Clostridium difficile (C. difficile) may worsen the prognosis of ulcerative colitis (UC). The objectives of this study were to: (i) validate the International Classification of Diseases-10 (ICD-10) code for C. difficile; (ii) determine the risk of C. difficile infection after diagnosis of UC; (iii) evaluate the effect of C. difficile infection on the risk of colectomy; and (iv) assess the association between C. difficile and postoperative complications.



The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing ICD-10 codes for C. difficile with stool toxin tests. A population-based surveillance cohort of newly diagnosed UC patients living in Alberta, Canada were identified from 2003 to 2009 (n=1,754). The effect of a C. difficile infection on colectomy was modeled using competing risk survival regression after adjusting for covariates. The effect of a C. difficile infection on postoperative complications was assessed using a mixed effects logistic regression model.



The sensitivity, specificity, PPV, and NPV of the ICD-10 code for C. difficile were 82.1%, 99.4%, 88.4%, and 99.1%, respectively. The risk of C. difficile infection within 5 years of diagnosis with UC was 3.4% (95% confidence interval (CI): 2.5-4.6%). The risk of colectomy was higher among UC patients diagnosed with C. difficile (sub-hazard ratio (sHR)=2.36; 95% CI: 1.47-3.80). C. difficile increased the risk of postoperative complications (odds ratio=4.84; 95% CI: 1.28-18.35). C. difficile was associated with mortality (sHR=2.56 times; 95% CI: 1.28-5.10).



C. difficile diagnosis worsens the prognosis of newly diagnosed patients with UC by increasing the risk of colectomy, postoperative complications, and death.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Departments of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada.
María E
ME
Negrón
Cedars-Sinai Medical Center, Los Angeles, California, USA.
Ali
A
Rezaie
Departments of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada.
Herman W
HW
Barkema
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kevin
K
Rioux
Departments of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada.
Jeroen
J
De Buck
Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada.
Sylvia
S
Checkley
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Paul L
PL
Beck
Department of Pediatrics, University of Alberta.
Matthew
M
Carroll
Department of Medicine, Division of Gastroenterology & Nutrition, University of Alberta, Edmonton, Alberta, Canada.
Richard N
RN
Fedorak
Department of Medicine, Division of Gastroenterology & Nutrition, University of Alberta, Edmonton, Alberta, Canada.
Levinus
L
Dieleman
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Remo
R
Panaccione
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Subrata
S
Ghosh
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Gilaad G
GG
Kaplan
D000328:Adult; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors