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Canadian Journal of Gastroenterology
Volume 17, Issue 6, Pages 369-373
Original Article

Clostridium difficile-Associated Diarrhea: Predictors of Severity in Patients Presenting to the Emergency Department

Christopher N Andrews,1 Janet Raboud,1 Barry O Kassen,1 and Robert Enns1

1Departments of Medicine, Health Care and Epidemiology, Canada
2Center for Health Evaluation and Outcome Sciences, St Paul’s Hospital, University of British Columbia, Vancouver, Canada
3Division of Gastroenterology, St Paul’s Hospital, University of British Columbia, Vancouver, Canada

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: Experiences with Clostridium difficile-associated diarrhea (CDAD) were reviewed to determine predictors of severity in patients presenting from the community.

METHODS: All patients admitted to two hospitals over 4.5 years with a primary diagnosis of CDAD were reviewed. Patients requiring a hospital stay of greater than 14 days, colectomy, intensive care unit admission or who died were classified as ’severe CDAD’ and compared with the remainder of the patients (termed ’mild CDAD’).

RESULTS: One hundred fifty-three patients (mean age 63.4±20.5 years, range 21 to 93, 64.7% female) were reviewed. Forty-four per cent of the patients had community-acquired CDAD, and the remainder had hospital-acquired disease. There were 44/153 (28.8%) patients with severe CDAD, of which 10/153 (6.5%) died. The severe group had more patients over 70 years old (75% versus 43% in the mild group, OR 3.09, CI 1.81-8.63, P<0.001) and had more comorbid disease (median two major organ systems affected [range zero to five] versus one [range zero to four] in the mild group, OR 1.52, CI 1.27-2.65, P<0.05). Patients with recurrent CDAD were more likely to have severe CDAD (12/44 versus 10/109 in the mild group, OR 4.10, CI 1.47-9.40, P<0.01).

CONCLUSION: Age over 70 years, comorbid illness and CDAD recurrence are significant risk factors for severe disease and a poor outcome in patients admitted to hospital for CDAD.