Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA.
Aliment Pharmacol Ther. 2012 Apr;35(7):789-95. doi: 10.1111/j.1365-2036.2012.05022.x. Epub 2012 Feb 23.
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.
To identify clinical and laboratory factors that predict severe outcomes associated with CDI in IBD patients.
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.
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.
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.
人们已经认识到，炎症性肠病（IBD）患者中艰难梭菌（C. difficile）感染（CDI）的发病率不断上升。然而，大多数研究都集中在证明 CDI 与 IBD 患者的不良结局相关。很少有研究试图确定与 IBD 患者 CDI 相关的严重结局的预测因素。
确定与 IBD 患者 CDI 相关的严重结局相关的临床和实验室因素。
我们从一个多机构的电子病历数据库中，确定了所有至少有一个艰难梭菌诊断代码的住院患者，这些患者患有克罗恩病或溃疡性结肠炎。我们的主要结局是在 CDI 后 180 天内全结肠切除或死亡的时间。Cox 比例风险模型用于从人口统计学、疾病相关、实验室和药物变量中确定主要结局的预测因素。
共有 294 例 CDI-IBD 患者纳入本研究。其中，58 例（20%）达到了我们的主要结局（45 例死亡，13 例结肠切除术），中位数为 31 天。多变量分析显示，血清白蛋白<3 g/dL（HR 5.75，95%CI 1.34-24.56）、血红蛋白<9 g/dL（HR 5.29，95%CI 1.58-17.69）和肌酐>1.5 mg/dL（HR 1.98，95%CI 1.04-3.79）是我们主要结局的独立预测因素。将实验室参数作为连续变量进行检查或将我们的主要结局缩短至 90 天内的事件，得到了类似的结果。
血清白蛋白<3 g/dL、血红蛋白<9 g/dL 和血清肌酐>1.5 mg/dL 是 IBD 患者住院期间发生 CDI 相关严重结局的独立预测因素。
