| Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. | |
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MedLine Citation:
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PMID: 18283139 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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John C Byrn; Dipen C Maun; Daniel S Gingold; Donald T Baril; Junko J Ozao; Celia M Divino |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 143 ISSN: 1538-3644 ISO Abbreviation: Arch Surg Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-19 Completed Date: 2008-03-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: United States |
Other Details:
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Languages: eng Pagination: 150-4; discussion 155 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Mount Sinai School of Medicine, 5 E 98th St, 15th Floor, Box 1259, New York, NY 10029, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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