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Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease.

Abstract：

BACKGROUND:The increasing incidence of Clostridium difficile (C. difficile) infection (CDI) among patients with inflammatory bowel disease is well recognised. However, most studies have focused on demonstrating that CDI is associated with adverse outcomes in IBD patients. Few have attempted to identify predictors of severe outcomes associated with CDI among IBD patients. AIM:To identify clinical and laboratory factors that predict severe outcomes associated with CDI in IBD patients. METHODS:From a multi-institution EMR database, we identified all hospitalised patients with at least one diagnosis code for C. difficile from among those with a diagnosis of Crohn's disease or ulcerative colitis. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Cox proportional hazards models were used to identify predictors of the primary outcome from among demographic, disease-related, laboratory and medication variables. RESULTS:A total of 294 patients with CDI-IBD were included in our study. Of these, 58 patients (20%) met our primary outcome (45 deaths, 13 colectomy) at a median of 31 days. On multivariate analysis, serum albumin <3 g/dL (HR 5.75, 95% CI 1.34-24.56), haemoglobin below 9 g/dL (HR 5.29, 95% CI 1.58-17.69) and creatinine above 1.5 mg/dL (HR 1.98, 95% CI 1.04-3.79) were independent predictors of our primary outcome. Examining laboratory parameters as continuous variables or shortening our primary outcome to include events within 90 days yielded similar results. CONCLUSION:Serum albumin below 3 g/dL, haemoglobin below 9 g/dL and serum creatinine above 1.5 mg/dL were independent predictors of severe outcomes in hospitalised IBD patients with Clostridium difficile infection.

journal_name

Aliment Pharmacol Ther

journal_title

Alimentary pharmacology & therapeutics

authors

Ananthakrishnan AN,Guzman-Perez R,Gainer V,Cai T,Churchill S,Kohane I,Plenge RM,Murphy S

doi

10.1111/j.1365-2036.2012.05022.x

subject

Has Abstract

pub_date

2012-04-01 00:00:00

pages

789-95

issue

eissn

0269-2813

issn

1365-2036

journal_volume

pub_type

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Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease.