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Fulminant Clostridium difficile Colitis Predictors for Mortality After Colectomy

Purpose: To identify risk factors for mortality in a patient who has undergone colectomy for fulminant Clostridium difficile colitis.

Description

Byrn et al evaluated patients who required colectomy for the management of fulminant Clostridium difficile colitis. Certain factors were associated with mortality and can help identify patients who may benefit from more aggressive management. The authors are from Mount Sinai School of Medicine and Albert Einstein School of Medicine in New York City.


Patient selection: colectomy for fulminant C. difficile disease. Most patients underwent subtotal colectomy with end-ileostomy.

 

Endpoint: in-hospital mortality following surgery

 

Risk factors for mortality on multivariate analysis:

(1) need for vasopressors prior to colectomy (hypotension or shock)

(2) changes in mental status

(3) delaying surgery while attempting to control the disease with medical management

 

Additional factors seen on the univariate analysis:

(1) delay in the correct diagnosis (admitted with another diagnosis)

(2) need for mechanical ventilation

 

where:

• Several of the factors are related to multi-organ failure (MOF).

• The change in mental status presumably is prior to the colectomy.


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Specialty

Objective

ICD-10