Predictors of Fatal Outcome after Colectomy for Fulminant Clostridium difficile Colitis: A 10-Year Experience

2011 ◽  
Vol 77 (8) ◽  
pp. 977-980 ◽  
Author(s):  
Alexey Markelov ◽  
David Livert ◽  
Harjeet Kohli
Keyword(s):  
Clostridium Difficile ◽  
Fatal Outcome ◽  
Length Of Hospital Stay ◽  
Predictors Of Mortality ◽  
Presenting Symptoms ◽  
Included Patient ◽  
Significant Difference ◽  
Timing Data ◽  
Clostridium Difficile Colitis ◽  
Mean Time

Surgical treatment of fulminant Clostridium difficile colitis has high mortality rates. Identification of a set of preoperative characteristics that could predict outcome after surgery is necessary to optimize clinical management and guide surgical timing. Data were retrospectively collected on patients operated on for C. difficile colitis between 2000 and 2010 at our institution. Statistical analysis was performed to identify predictors of mortality. We reviewed the records of 13 inpatients diagnosed as having C. difficile colitis and who underwent colectomy during the same admission. The in-hospital mortality rate for patients undergoing colectomy for colitis was 46.2 per cent. Independent predictors of mortality included the following: white blood cell count (34,600/μL or greater), hypoalbuminemia (1.5 g/dL or less), septic shock with requirements of vasopressors, and respiratory failure. Patients who underwent colectomy earlier (mean time from presentation to surgery 2.4 ± 1.5 days) had decreased mortality ( P = 0.019).). Longer length of hospital stay to the time of diagnosis was associated with higher rates of fatal outcome ( P = 0.031). Parameters without significant difference ( P > 0.05) included patient age, presenting symptoms, other comorbidities, creatinine levels, and CT scan findings. Identified factors can predict unfavorable outcomes after colectomy. Aggressive surgical intervention early in the course of the disease might be associated with improved survival.

Frailty Predicts Morbidity and Mortality after Colectomy for Clostridium difficile Colitis

2018 ◽  
Vol 84 (5) ◽  
pp. 628-632
Author(s):  
Raghunandan Venkat ◽  
Viraj Pandit ◽  
Edwin Telemi ◽  
Oleksandr Trofymenko ◽  
Twinkle K. Pandian ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Frailty Index ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Class Iii ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Length ◽  
Increased Risk ◽  
Clostridium Difficile Colitis

Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for Clostridium difficile colitis. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 470 patients with a diagnosis of C. difficile colitis were used in the study. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used with the National Surgical Quality and Improvement Program to assess frailty. Outcome measures included serious morbidity, overall morbidity, and Clavien IV (requiring ICU) and Clavien V (mortality) complications. The median age was 70 years and body mass index was 26.9 kg/m2. 55.6 per cent of patients were females. 98.5 per cent of patients were assigned American Society of Anesthesiologists Class III or higher. The median mFI was 0.27 (0–0.63). Because mFI increased from 0 (non-frail) to 0.55 and above, the overall morbidity increased from 53.3 per cent to 84.4 per cent and serious morbidity increased from 43.3 per cent to 78.1 per cent. The Clavien IV complication rate increased from 30.0 per cent to 75.0 per cent. The mortality rate increased from 6.7 per cent to 56.2 per cent. On a multivariate analysis, mFI was an independent predictor ofoverall morbidity (AOR: 13.0; P < 0.05), mortality (AOR: 8.8; P = 0.018), cardiopulmonary complications (AOR: 6.8; P = 0.026), and prolonged length of hospital stay (AOR: 6.6; P = 0.045). Frailty is associated with increased risk of complications in C. difficile colitis patients undergoing colectomy. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients who generally have significant morbidity and mortality to begin with.

Predictors of Mortality After Emergency Colectomy for Clostridium Difficile Colitis

2014 ◽  
Vol 259 (1) ◽  
pp. 148-156 ◽  
Author(s):  
David Y. Lee ◽  
Eunice L. Chung ◽  
Hamza Guend ◽  
Richard L. Whelan ◽  
Raymond V. Wedderburn ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Predictors Of Mortality ◽  
Emergency Colectomy ◽  
Clostridium Difficile Colitis

scholarly journals The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yvette Farrugia ◽  
Bernard Paul Spiteri Meilak ◽  
Neil Grech ◽  
Rachelle Asciak ◽  
Liberato Camilleri ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Obstructive Pulmonary Disease ◽  
Predictors Of Mortality ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

Inhibition of the Renin Angiotensin System During Autologous Stem Cell Transplant Does Not Impact Time to Engraftment □s€

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4502-4502
Author(s):  
Anita J. Kumar ◽  
Joseph R Carver ◽  
Noelle V. Frey
Keyword(s):  
Multiple Myeloma ◽  
Treatment Group ◽  
Length Of Hospital Stay ◽  
Renin Angiotensin System ◽  
Control Group ◽  
Cell Transplant ◽  
Angiotensin System ◽  
Significant Difference ◽  
Mean Time ◽  
Neutrophil Engraftment

Abstract Abstract 4502 Background: The renin angiotensin system modulates hematopoiesis via local effects in the bone marrow. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may adversely impact hematopoiesis and time to engraftment in patients undergoing stem cell transplant (SCT). Our study assesses whether the use of ACEi or ARBs delays time to engraftment in patients with multiple myeloma undergoing a melphalan based autologous SCT. Methods: A retrospective review of 58 patients who underwent autologous SCT with a melphalan 200 mg/m2 conditioning regimen for multiple myeloma between January 1 and December 31, 2010 was performed. Neutrophil engraftment was defined as an absolute neutrophil count greater than or equal to 500 cells/uL that persisted for at least three days. Platelet engraftment was defined as achieving platelets of at least 20,000 cells/uL that persisted for at least three days. Time to engraftment was defined as number of days from Day 0 of SCT to the first day of platelet or neutrophil engraftment. Results: Of 58 evaluable patients, 47 underwent autologous SCT without an ACEi or ARB (control group), and 11 patients were given an ACEi or ARB (treatment group). Mean time to neutrophil engraftment was 11.5 days in the control group, and 11.3 days in treatment group (p=0.6). Mean time to platelet engraftment in control group was 13.5 days and 15.1 days in treatment group (p=0.2). There was no statistically significant difference between groups in time to neutropenic fever and length of hospital stay. Conclusion: Our study demonstrates no significant difference in time to engraftment, incidence of neutropenic fever, or length of hospital stay between patients receiving ACEi or ARBS compared to control subjects. We demonstrate that use of low to moderate dose ACEi or ARB is not associated with prolonged time to engraftment and is safe to use in patients undergoing autologous SCT for multiple myeloma. Disclosures: No relevant conflicts of interest to declare.

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