Singh Anupam Kumar, Shukla Siddharth, Acharya Ritesh, Birda Chhagan Lal, Sah Pramod Kumar, Singh Shravya, Jearth Vaneet, Shah Jimil, Agarwal Ashish, Sharma Arun Kumar, Sakaray Yashwant Raj, Sinha Saroj Kant, Dutta Usha
Department of Gastroenterology.
Department of Medicine and Gastroenterology, Army Base Hospital, Guwahati.
J Clin Gastroenterol. 2025 May 12. doi: 10.1097/MCG.0000000000002196.
Clostridioides difficile infection (CDI) and acute severe ulcerative colitis (ASUC) are both independently associated with poor outcome. The impact of CDI on the outcome of severe flare of ulcerative colitis is not studied. In the current study, we assess the impact of CDI on the outcome of ASUC.
Data of ASUC patients were collected from January 2022 to July 2024. Parameters included were demographic profile, disease characteristics, biochemical investigations, and stool C. difficile toxin A/B (CDTA). Patients were categorized into ASUC-CDI and ASUC groups. Primary outcomes were need of rescue therapy, colectomy, and mortality during index admission. Six-month outcomes were flare of disease, colectomy, and mortality.
Of the 117 patients included, 91 (77.8%) patients were in the ASUC group and 26 (22.2%) in the ASUC-CDI group. Baseline parameters were similar between the 2 groups. Overall, 86 (73.5%) patients responded to corticosteroid therapy. Need of rescue therapy (24.2% vs. 33.6%, P=0.287), colectomy (3.3% vs. 11.5%, P=0.093), and mortality (1.1% vs. 3.8%, P=0.345) rates were comparable between the ASUC and ASUC-CDI groups. Six-month colectomy (4.4% vs. 15.4%) and mortality (1.1% vs. 7.7%) rates were numerically higher in the ASUC-CDI group, though statistically nonsignificant.
The immediate and short-term outcome of patients with acute severe ulcerative colitis in the presence of C. difficile infection is determined by the severity of ulcerative colitis flare.
艰难梭菌感染（CDI）和急性重症溃疡性结肠炎（ASUC）均与不良预后独立相关。CDI对溃疡性结肠炎严重发作结局的影响尚未得到研究。在本研究中，我们评估了CDI对ASUC结局的影响。
收集2022年1月至2024年7月ASUC患者的数据。纳入的参数包括人口统计学特征、疾病特征、生化检查和粪便艰难梭菌毒素A/B（CDTA）。患者被分为ASUC-CDI组和ASUC组。主要结局为在首次住院期间是否需要挽救治疗、结肠切除术和死亡率。六个月的结局为疾病复发、结肠切除术和死亡率。
在纳入的117例患者中，91例（77.8%）患者在ASUC组，26例（22.2%）在ASUC-CDI组。两组之间的基线参数相似。总体而言，86例（73.5%）患者对皮质类固醇治疗有反应。ASUC组和ASUC-CDI组之间的挽救治疗需求（24.2%对33.6%，P=0.287）、结肠切除术（3.3%对11.5%，P=0.093）和死亡率（1.1%对3.8%，P=0.345）率相当。ASUC-CDI组的六个月结肠切除术（4.4%对15.4%）和死亡率（1.1%对7.7%）率在数值上更高，尽管在统计学上无显著差异。
存在艰难梭菌感染的急性重症溃疡性结肠炎患者的即刻和短期结局取决于溃疡性结肠炎发作的严重程度。
