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Predictors of Ananthakrishnan et al for a Severe Outcome in a Patient with Inflammatory Bowel Disease (IBD) Who Is Infected with Clostridium difficile

Purpose: To identify a patient with inflammatory bowel disease (IBD) and Clostridium difficile colitis who is at risk for a severe outcome.

Description

Ananthakrishnan et al listed risk factors for a severe outcome in a patient with inflammatory bowel disease who becomes infected with Clostridium difficile. These can help to identify a patient who may benefit from more aggressive management. The authors are from Massachusetts General Hospital and Harvard Medical School.


Patient selection: inflammatory bowel disease with Clostridium difficile disease

 

Severe outcomes: total colectomy or death within 180 days after Clostridium difficile infection onset

 

Parameters from multivariate analysis:

(1) serum albumin in g/dL

(2) hemoglobin in g/dL

(3) serum creatinine in mg/dL

 

Parameter

Finding

Points

serum albumin

>= 3 g/dL

0

 

< 3 g/dL

1

hemoglobin

>= 9 g/dL

0

 

< 9 g/dL

1

serum creatinine

<= 1.5 mg/dL

0

 

> 1.5 mg/dL

1

 

total number of risk factors =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 3

• The risk of a severe outcome increases as the number of risk factors increases.

• In the conclusion the authors indicate that serum albumin is probably the most important finding.

 

Additonal risk factors to consider from the univariate analysis:

(1) age >= 50 years

(2) not being treated with 5-ASA, an immunomodulator or anti-TNF


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Specialty

Objective

ICD-10