S0262 The Predictors of of Toxic Megacolon in Patients With Clostridioides difficile Infection

Abstract

INTRODUCTION: Clostridioides difficile is anaerobic, gram-positive bacillus that can cause considerable morbidity and mortality. Toxic megacolon (TMC) is one of the most serious complications associated with Clostridioides difficile infection (CDI) which can lead to increased morbidity and mortality. Therefore, we conducted this study to assess the predictors for TMC in patients CDI using very large inpatient database. METHODS: We queried data from the National Inpatient Sample (NIS) database between 2002 and 2014. We identified all adult patients (≥ 18 year old ) who were diagnosed with CDI using the International Classification of Diseases ICD-9 codes. We divided the patients into two groups: patients with TMC (study group) and patients without TMC (control group). We assessed the predictors of TMC using multivariable logistic regression. RESULTS: We identified total of 802,293 patients between 2002 and 2014 who had CDI. Patients with TMC were older (71 vs 69), less likely to be female (58.5% vs 53.9%) and more likely to be Caucasian (80.7% vs 75.8%). In addition, patients in the study group were more likely to be obese (7.7% vs 6.7%, P < 0.001). Using multivariable analysis and after adjusting for potential cofounding factors including age, gender, obesity and Elixhauser comorbidities, Patients with coagulopathy were 50 % more likely to have TMC [Odds Ratio (OR): 1.5, 95% confidence interval (CI): 1.21–1.86, P < 0.001]. Additionally, TMC patients were more likely to have paraplegia [OR: 1.61, 95% CI: 1.25–2.07, P < 0.05], peripheral vascular disease (PVD) [OR: 1.37, 95% CI: 1.1–1.6], electrolytes abnormalities [OR: 1.8, 95% CI: 1.55–2.11] and malnutrition [OR: 2.29, 95% CI: 1.97–2.66], P < 0.05 for all. CONCLUSION: To our knowledge, this is the largest study that evaluated the risk of TMC in patients with CDI. We found that patients with TMC are older. In addition, patients with PVD, paraplegia, electrolyte abnormalities, coagulopathy and malnutrition are at higher risk for TMC. Early recognition of TMC during CDI and appropriate management are essential to improve outcomes in this population.