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

被引:73
作者
Ananthakrishnan, A. N. [1 ,2 ]
Guzman-Perez, R. [3 ]
Gainer, V. [3 ]
Cai, T. [4 ]
Churchill, S. [5 ]
Kohane, I. [2 ,5 ]
Plenge, R. M. [6 ]
Murphy, S. [3 ,5 ]
机构
[1] Massachusetts Gen Hosp, Crohns & Colitis Ctr, Gastrointestinal Unit, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Partners Hlth Care Syst, Informat, Boston, MA USA
[4] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[5] I2b2 Natl Ctr Biomed Comp, Boston, MA USA
[6] Brigham & Womens Hosp, Div Rheumatol Immunol & Allergy, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
ULCERATIVE-COLITIS; DIARRHEA; EPIDEMIOLOGY; BURDEN; GUIDELINES; VANCOMYCIN; DIAGNOSIS; UPDATE; IMPACT;
D O I
10.1111/j.1365-2036.2012.05022.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:789 / 795
页数:7
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