Clostridium difficile colitis in the united states: A decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy

Wissam J Halabi, Vinh Q. Nguyen, Joseph C. Carmichael, Alessio Pigazzi, Michael J. Stamos, Steven Mills

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background Clostridium difficile colitis (CDC) is a major health concern in the United States (US), with earlier reports demonstrating a rising incidence. Studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers. Study Design The Nationwide Inpatient Sample (NIS) 2001 to 2010 was retrospectively reviewed for CDC trends, the associated colectomy and mortality rates. Patient and hospital variables were used in the LASSO algorithm for logistic regression with 10-fold cross validation to build a predictive model for colectomy requirement and mortality after colectomy. The association of colectomy day with mortality was also examined on multivariable logistic regression analysis. Results An estimated 2,773,521 discharges with a diagnosis of CDC were identified in the US over a decade. Colectomy was required in 19,374 cases (0.7%), with an associated mortality of 30.7%. Compared with the 2001 to 2005 period, the 2006 to 2010 period witnessed a 47% increase in the rate of CDC and a 32% increase in the rate of colectomies. The LASSO algorithm identified the following predictors for colectomy: coagulopathy (odds ratio [OR] 2.71), weight loss (OR 2.25), teaching hospitals (OR 1.37), fluid or electrolyte disorders (OR 1.31), and large hospitals (OR 1.18). The predictors of mortality after colectomy were: coagulopathy (OR 2.38), age greater than 60 years (OR 1.97), acute renal failure (OR 1.67), respiratory failure (OR 1.61), sepsis (OR 1.40), peripheral vascular disease (OR 1.39), and congestive heart failure (OR 1.25). Surgery more than 3 days after admission was associated with higher mortality rates (OR 1.09; 95% CI 1.05 to 1.14; p < 0.05). Conclusions Clostridium difficile colitis is increasing in the US, with an associated increase in total colectomies. Mortality rates after colectomy remain elevated. Progression to colectomy and mortality thereafter are associated with several patient and hospital factors. Knowledge of these risk factors may help in risk-stratification and counseling.

Original languageEnglish (US)
Pages (from-to)802-812
Number of pages11
JournalJournal of the American College of Surgeons
Volume217
Issue number5
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

Fingerprint

Clostridium difficile
Colectomy
Colitis
Odds Ratio
Mortality
Logistic Models
Peripheral Vascular Diseases
Acute Kidney Injury
Teaching Hospitals
Respiratory Insufficiency
Electrolytes
Counseling
Weight Loss
Inpatients
Sepsis
Heart Failure

Keywords

  • Abbreviations and Acronyms
  • CDC
  • Clostridium difficile colitis
  • Nationwide Inpatient Sample
  • NIS
  • odds ratio
  • OR

ASJC Scopus subject areas

  • Surgery

Cite this

Clostridium difficile colitis in the united states : A decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy. / Halabi, Wissam J; Nguyen, Vinh Q.; Carmichael, Joseph C.; Pigazzi, Alessio; Stamos, Michael J.; Mills, Steven.

In: Journal of the American College of Surgeons, Vol. 217, No. 5, 01.11.2013, p. 802-812.

Research output: Contribution to journalArticle

Halabi, Wissam J ; Nguyen, Vinh Q. ; Carmichael, Joseph C. ; Pigazzi, Alessio ; Stamos, Michael J. ; Mills, Steven. / Clostridium difficile colitis in the united states : A decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy. In: Journal of the American College of Surgeons. 2013 ; Vol. 217, No. 5. pp. 802-812.
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abstract = "Background Clostridium difficile colitis (CDC) is a major health concern in the United States (US), with earlier reports demonstrating a rising incidence. Studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers. Study Design The Nationwide Inpatient Sample (NIS) 2001 to 2010 was retrospectively reviewed for CDC trends, the associated colectomy and mortality rates. Patient and hospital variables were used in the LASSO algorithm for logistic regression with 10-fold cross validation to build a predictive model for colectomy requirement and mortality after colectomy. The association of colectomy day with mortality was also examined on multivariable logistic regression analysis. Results An estimated 2,773,521 discharges with a diagnosis of CDC were identified in the US over a decade. Colectomy was required in 19,374 cases (0.7{\%}), with an associated mortality of 30.7{\%}. Compared with the 2001 to 2005 period, the 2006 to 2010 period witnessed a 47{\%} increase in the rate of CDC and a 32{\%} increase in the rate of colectomies. The LASSO algorithm identified the following predictors for colectomy: coagulopathy (odds ratio [OR] 2.71), weight loss (OR 2.25), teaching hospitals (OR 1.37), fluid or electrolyte disorders (OR 1.31), and large hospitals (OR 1.18). The predictors of mortality after colectomy were: coagulopathy (OR 2.38), age greater than 60 years (OR 1.97), acute renal failure (OR 1.67), respiratory failure (OR 1.61), sepsis (OR 1.40), peripheral vascular disease (OR 1.39), and congestive heart failure (OR 1.25). Surgery more than 3 days after admission was associated with higher mortality rates (OR 1.09; 95{\%} CI 1.05 to 1.14; p < 0.05). Conclusions Clostridium difficile colitis is increasing in the US, with an associated increase in total colectomies. Mortality rates after colectomy remain elevated. Progression to colectomy and mortality thereafter are associated with several patient and hospital factors. Knowledge of these risk factors may help in risk-stratification and counseling.",
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AU - Nguyen, Vinh Q.

AU - Carmichael, Joseph C.

AU - Pigazzi, Alessio

AU - Stamos, Michael J.

AU - Mills, Steven

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background Clostridium difficile colitis (CDC) is a major health concern in the United States (US), with earlier reports demonstrating a rising incidence. Studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers. Study Design The Nationwide Inpatient Sample (NIS) 2001 to 2010 was retrospectively reviewed for CDC trends, the associated colectomy and mortality rates. Patient and hospital variables were used in the LASSO algorithm for logistic regression with 10-fold cross validation to build a predictive model for colectomy requirement and mortality after colectomy. The association of colectomy day with mortality was also examined on multivariable logistic regression analysis. Results An estimated 2,773,521 discharges with a diagnosis of CDC were identified in the US over a decade. Colectomy was required in 19,374 cases (0.7%), with an associated mortality of 30.7%. Compared with the 2001 to 2005 period, the 2006 to 2010 period witnessed a 47% increase in the rate of CDC and a 32% increase in the rate of colectomies. The LASSO algorithm identified the following predictors for colectomy: coagulopathy (odds ratio [OR] 2.71), weight loss (OR 2.25), teaching hospitals (OR 1.37), fluid or electrolyte disorders (OR 1.31), and large hospitals (OR 1.18). The predictors of mortality after colectomy were: coagulopathy (OR 2.38), age greater than 60 years (OR 1.97), acute renal failure (OR 1.67), respiratory failure (OR 1.61), sepsis (OR 1.40), peripheral vascular disease (OR 1.39), and congestive heart failure (OR 1.25). Surgery more than 3 days after admission was associated with higher mortality rates (OR 1.09; 95% CI 1.05 to 1.14; p < 0.05). Conclusions Clostridium difficile colitis is increasing in the US, with an associated increase in total colectomies. Mortality rates after colectomy remain elevated. Progression to colectomy and mortality thereafter are associated with several patient and hospital factors. Knowledge of these risk factors may help in risk-stratification and counseling.

AB - Background Clostridium difficile colitis (CDC) is a major health concern in the United States (US), with earlier reports demonstrating a rising incidence. Studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers. Study Design The Nationwide Inpatient Sample (NIS) 2001 to 2010 was retrospectively reviewed for CDC trends, the associated colectomy and mortality rates. Patient and hospital variables were used in the LASSO algorithm for logistic regression with 10-fold cross validation to build a predictive model for colectomy requirement and mortality after colectomy. The association of colectomy day with mortality was also examined on multivariable logistic regression analysis. Results An estimated 2,773,521 discharges with a diagnosis of CDC were identified in the US over a decade. Colectomy was required in 19,374 cases (0.7%), with an associated mortality of 30.7%. Compared with the 2001 to 2005 period, the 2006 to 2010 period witnessed a 47% increase in the rate of CDC and a 32% increase in the rate of colectomies. The LASSO algorithm identified the following predictors for colectomy: coagulopathy (odds ratio [OR] 2.71), weight loss (OR 2.25), teaching hospitals (OR 1.37), fluid or electrolyte disorders (OR 1.31), and large hospitals (OR 1.18). The predictors of mortality after colectomy were: coagulopathy (OR 2.38), age greater than 60 years (OR 1.97), acute renal failure (OR 1.67), respiratory failure (OR 1.61), sepsis (OR 1.40), peripheral vascular disease (OR 1.39), and congestive heart failure (OR 1.25). Surgery more than 3 days after admission was associated with higher mortality rates (OR 1.09; 95% CI 1.05 to 1.14; p < 0.05). Conclusions Clostridium difficile colitis is increasing in the US, with an associated increase in total colectomies. Mortality rates after colectomy remain elevated. Progression to colectomy and mortality thereafter are associated with several patient and hospital factors. Knowledge of these risk factors may help in risk-stratification and counseling.

KW - Abbreviations and Acronyms

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KW - Clostridium difficile colitis

KW - Nationwide Inpatient Sample

KW - NIS

KW - odds ratio

KW - OR

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