Document Detail


Predictors of mortality after colectomy for fulminant Clostridium difficile colitis.
MedLine Citation:
PMID:  18283139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To present, to our knowledge, the largest experience with colectomy for fulminant Clostridium difficile colitis and to propose factors significant in predicting mortality. DESIGN: Retrospective medical record review. SETTING: University teaching hospital. PATIENTS: Seventy-three patients undergoing colectomy between 1994 and 2005 for C difficile-associated pseudomembranous colitis. MAIN OUTCOME MEASURES: Preoperative predictors of in-hospital mortality. RESULTS: Seventy-three of 5718 cases (1.3%) of C difficile colitis required colectomy. Mean age was 68 years. In-hospital mortality was 34% (n = 25). Eighty-six percent (n = 63) of patients received a subtotal colectomy. Patients presented with diarrhea (84%; n = 61), abdominal pain (75%; n = 55), and ileus (16%; n = 12). Mean duration of symptoms was 7 days followed by 4 days of medical treatment prior to colectomy. On univariate analysis, an admitting diagnosis other than C difficile (P = .049), vasopressor requirement (P = .001), intubation (P = .001), and mental status changes (P < .001) were significant predictors of mortality. Arterial lactate level (4.9 vs 2.4 mmol/L; P = .007) was significantly higher and length of medical management (6.4 vs 3.0 days; P = .006) was significantly longer in the mortality group. Platelet counts (169 x 10(3)/microL vs 261 x 10(3)/microL [to convert to x 10(9)/L, multiply by 1]; P = .04) were significantly lower in the mortality group. On multivariate analysis, vasopressor requirement (P = .04; odds ratio, 5.0), mental status changes (P = .002; odds ratio, 12.6), and treatment length (P = .002; odds ratio, 1.4) remained significant predictors of mortality. CONCLUSIONS: Colectomy for C difficile colitis carries a substantial mortality regardless of patient age and white blood cell count. Preoperative vasopressor requirement, mental status changes, and length of medical treatment significantly predict mortality.
Authors:
John C Byrn; Dipen C Maun; Daniel S Gingold; Donald T Baril; Junko J Ozao; Celia M Divino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  143     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-19     Completed Date:  2008-03-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  150-4; discussion 155     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Mount Sinai School of Medicine, 5 E 98th St, 15th Floor, Box 1259, New York, NY 10029, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Analysis of Variance
Bacteremia / diagnosis,  mortality,  surgery
Cause of Death
Clostridium Infections / diagnosis,  mortality*,  surgery*
Clostridium difficile / pathogenicity*
Colectomy / adverse effects,  methods
Enterocolitis, Pseudomembranous / microbiology,  mortality*,  surgery*
Female
Follow-Up Studies
Hospital Mortality / trends
Hospitals, University
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Probability
Registries
Retrospective Studies
Risk Assessment
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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