Criteria for fulminant Clostridium difficile colitis:
(1) systemic toxic effects and shock
(2) complicated by toxic megacolon, colonic perforation or severe colitis
(3) results in either the need for colectomy or death
Factors associated with a worse prognosis:
(1) age
(2) leukocytosis (>= 35,000 per µL) and/or left shift (bans >=10%) (abnormal white blood cell count)
(3) need for vasopressors and/or intubation (cardiopulmonary failure)
|
Age
|
Abnormal WBC
|
Cardiopulmonary Failure
|
Mortality
|
|
< 70 years
|
No
|
No
|
0%
|
|
< 70 years
|
No
|
Yes
|
17%
|
|
< 70 years
|
Yes
|
No
|
0%
|
|
< 70 years
|
Yes
|
Yes
|
44%
|
|
>= 70 years
|
No
|
No
|
0%
|
|
>= 70 years
|
No
|
Yes
|
44%
|
|
>= 70 years
|
Yes
|
No
|
28%
|
|
>= 70 years
|
Yes
|
Yes
|
57%
|
where:
• Cardiopulmonary arrest seems to be the dominant risk factor.
Factors associated with improved prognosis:
(1) therapy with oral vancomycin
(2) early colectomy (often associated with being managed on a surgical service)
