Background: C difficile colitis (CDC) is a disease with a wide clinical spectrum ranging from mild diarrhea to fulminant and potentially fatal colitis. The pathophysiological mechanisms for this variation remain poorly understood. A total abdominal colectomy may be life-saving if performed before the point of no-return has already been passed. Identification of negative prognostic factors is therefore desperately needed for optimization of the clinical and operative management.
Methods: Hospitalized patients who were diagnosed with C. difficile infection were identified through the prospective database and the medical records retrospectively reviewed. Excluded were only patients with relevant chart deficiencies. Data collected included general demographics, underlying medical conditions, APACHE II score, clinical and laboratory data, duration of the conservative treatment. Mortality and cure were the two endpoints. Regression analysis was used to identify parameters associated wih mortality.
Results: 201 patients (mean age 57, range 20-94) with CDC could be identified and analyzed from our tertiary institution. Mortality in the patient collective was 8% (16 out of 201 pts). Patients with fatal outcome had a longer pre-CDC hospital stay (18.6 vs. 8.7 days), a higher prevalence of COPD, CAD and steroid use, whereas posttransplant status as such was not associated with an increased mortality. Clinical parameters associated with mortality included abdominal distension, mental status change, evidence of respiratory and renal organ failure, albumin <3.0, and an increased APACHE II score. In 40% of patients undergoing an emergency colectomy, the decision for surgery came too late in the course of the disease.
Conclusion: Our retrospective study identified several factors which were associated with mortality. Future clinical studies will have to focus on these parameters to assess in which form they ought to be included in the clinical decision-making process and suggest a need for an earlier surgical intervention.