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C. difficile increases mortality, colectomy, complication risk in UC
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Clostridium difficile infection results in a poorer prognosis among patients newly diagnosed with ulcerative colitis, as it increases their risk for colectomy, postoperative complications and death, according to a population-based inception cohort study.
Previous studies have shown that patients with UC have a higher risk for acquiring C. difficile compared with Crohn’s patients and the general population, and that CDIs are associated with an increased risk for colectomy and postoperative complications, Gilaad G. Kaplan, MD, MPH, FRCPC, from the departments of medicine and community health sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada, and colleagues wrote. In this study, they aimed to validate the ICD-10 diagnostic code for CDI in UC patients, and determine the cumulative risk of CDI after UC diagnosis, the effect of CDI on colectomy and mortality risk, and the association between CDI and postoperative complications.
Gilaad G. Kaplan
They identified 1,754 Alberta residents diagnosed with UC from April 2003 through March 2010, used a competing risk survival regression model to evaluate the effect of CDI on colectomy, and used a mixed effects logistic regression model to evaluate the effect of CDI on postoperative complications. They used a separate study population (1,686 UC patients admitted to Calgary hospitals from 2002 to 2009) for their validation study, in which they calculated sensitivity, specificity, positive and negative predictive value of the ICD-10 code for identifying CDI in UC patients by comparing the code with stool toxin tests.
The ICD-10 code identified CDI in UC patients with 82.1% sensitivity, 99.4% specificity, 88.4% positive predictive value and 99.1% negative predictive value.
Risk for CDI within 5 years of UC diagnosis was 3.4% (95% CI, 2.5-4.6). After adjusting for age, sex and comorbidities, the researchers observed that risk for colectomy was higher in UC patients who were diagnosed with CDI vs. those who were not (sub-HR = 2.36; 95% CI, 1.47-3.8), as was mortality risk (HR = 2.56 times; 95% CI, 1.28-5.1). CDI diagnosed at least 90 days before colectomy was associated with an increased risk for postoperative complications (adjusted OR = 4.84; 95% CI, 1.28-18.35).
“Collectively, these data suggest that a diagnosis of C. difficile worsens the course of UC,” the researchers concluded. “These findings have important clinical implications. First, physicians should carefully assess for C. difficile infection among all UC patients. However, special attention should be given to those presenting with C. difficile early in the UC disease course and carefully monitor them as they are at an increased risk of colectomy and postoperative complications.” – by Adam Leitenberger
Disclosure: The researchers and editorial authors report no relevant financial disclosures.
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