|Predictors of mortality after colectomy for fulminant Clostridium difficile colitis.|
|PMID: 18283139 Owner: NLM Status: MEDLINE|
|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.|
|John C Byrn; Dipen C Maun; Daniel S Gingold; Donald T Baril; Junko J Ozao; Celia M Divino|
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|Type: Journal Article|
|Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 143 ISSN: 1538-3644 ISO Abbreviation: Arch Surg Publication Date: 2008 Feb|
|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|
|Languages: eng Pagination: 150-4; discussion 155 Citation Subset: AIM; IM|
|Department of Surgery, Mount Sinai School of Medicine, 5 E 98th St, 15th Floor, Box 1259, New York, NY 10029, USA.|
|APA/MLA Format Download EndNote Download BibTex|
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*
Hospital Mortality / trends
Predictive Value of Tests
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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