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Predictors of Mortality After Colectomy for Fulminant Clostridium difficile Colitis

2008; American Medical Association; Volume: 143; Issue: 2 Linguagem: Inglês

10.1001/archsurg.2007.46

1538-3644

John C. Byrn,

Gastrointestinal motility and disorders

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.Inhospital 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 (PϽ.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 (169ϫ10 3 /µL vs 261ϫ10 3 /µL [to convert to ϫ10 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.