Risk factors for severity and relapse of pseudomembranous colitis in an elderly population
M Moshkowitz1, E Ben-Baruch, Z Kline
1Department of Gastroenterology, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel. moshkov7@zahav.net.it
Objective:
Pseudomembranous colitis (PMC) is well recognized as an important cause of diarrhoea in patients receiving antibiotics, with significant consequences of morbidity and mortality. Mortality among elderly patients is high, and even with successful treatment, a significant number of patients relapse. To evaluate the outcome of elderly patients with PMC, and to try to identify risk factors that might influence mortality or relapse.
Method:
We studied 72 consecutive hospitalized patients with endoscopically proven PMC. The medical records of all patients with their clinical history and laboratory data were reviewed in detail. These data included: pre-hospitalization residence and physical status, background medical history, presenting symptoms, antibiotic history, haematological and biochemical parameters, treatment, duration of hospitalization, complications, mortality within 30 days of hospitalization and relapse.
Results:
Of the 72 patients (M/F=34/38, mean age=77 years), 47% were nursing home residents. Prior to hospitalization, 91.6% of patients had received antibiotic treatment (cephalosporins - 64%, penicillins - 42% and quinolones - 28%), 26% of patients received antacid therapy and 36% had been fed with a nasogastric tube (NGT). Thirty-seven (51%) patients recovered without complications, 21 (29%) patients died within 30 days of hospitalization and 14 (19%) patients were re-hospitalized because of relapse of PMC. Multivariate analysis revealed that white blood cell count above 20 x 10(3)/mm3 (P=0.009), serum albumin level of less than 2.5 g/dl (P=0.02), and pre-hospitalization NGT feeding (P=0.01) were associated with high mortality. Treatment with acid-reducing drugs (P=0.01) and living at a nursing home (P=0.06) were associated with high relapse rates.
Conclusion:
Pseudomembranous colitis is an important complication of antibiotic therapy and is associated with high mortality and recurrence rate, especially in old and debilitated persons. Pre-admission NGT feeding, severe leucocytosis and hypoalbuminaemia on admission are associated with increased mortality. Pre-hospitalization acid reducing treatment and nursing home residency are associated with increased risk of recurrence.
Insights
Pseudomembranous colitis (PMC) in elderly patients leads to high mortality and relapse rates. Risk factors for death include high white blood cell count and low albumin, while nursing home residency and acid-reducing drugs increase relapse risk.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Geriatrics
Background:
- Pseudomembranous colitis (PMC) is a significant complication of antibiotic therapy, particularly in elderly patients, often leading to high morbidity and mortality.
- Elderly individuals with PMC face a considerable risk of relapse even after successful treatment, posing a challenge in clinical management.
Purpose of the Study:
- To evaluate the outcomes of elderly patients diagnosed with pseudomembranous colitis.
- To identify specific risk factors associated with increased mortality and recurrence rates in this patient population.
Main Methods:
- A retrospective study of 72 hospitalized patients with endoscopically confirmed PMC.
- Detailed review of medical records, including patient history, laboratory data, antibiotic and antacid use, nasogastric tube (NGT) feeding, treatment, hospitalization duration, complications, mortality, and relapse.
Main Results:
- Of 72 patients (mean age 77), 47% were nursing home residents. Antibiotic treatment preceded hospitalization in 91.6%.
- Mortality within 30 days was 29%, and 19% experienced relapse. High white blood cell count (>20 x 10^3/mm3), low serum albumin (<2.5 g/dl), and pre-hospitalization NGT feeding were linked to increased mortality.
- Acid-reducing drug use and nursing home residency were associated with higher relapse rates.
Conclusions:
- Pseudomembranous colitis is a serious complication of antibiotic use in the elderly, characterized by high mortality and recurrence.
- Key predictors of mortality include severe leukocytosis, hypoalbuminemia, and pre-admission nasogastric tube feeding.
- Pre-hospitalization use of acid-reducing agents and residence in a nursing home are significant risk factors for PMC recurrence in elderly patients.
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