Original Article

Impact of Clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis

  1. S. K. Murthy1,*,
  2. A. H. Steinhart1,2,
  3. J. Tinmouth2,3,4,
  4. P. C. Austin2,4,
  5. N. Daneman2,4,5,
  6. G. C. Nguyen1,2,4

Article first published online: 14 OCT 2012

DOI: 10.1111/apt.12073

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 36, Issue 11-12, pages 1032–1039, December 2012

Additional Information

How to Cite

Murthy, S. K., Steinhart, A. H., Tinmouth, J., Austin, P. C., Daneman, N. and Nguyen, G. C. (2012), Impact of Clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis. Alimentary Pharmacology & Therapeutics, 36: 1032–1039. doi: 10.1111/apt.12073

Author Information

  1. 1

    Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada

  2. 2

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

  3. 3

    Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

  4. 4

    Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

  5. 5

    Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

* Correspondence to:
Dr S. K. Murthy, 445–600 University Avenue, Toronto, ON M5G 1X5, Canada.
E-mail: sanjay.murthy@utoronto.ca

Publication History

  1. Issue published online: 7 NOV 2012
  2. Article first published online: 14 OCT 2012
  3. Manuscript Accepted: 15 SEP 2012
  4. Manuscript Revised: 12 SEP 2012
  5. Manuscript Revised: 30 MAY 2012
  6. Manuscript Received: 1 MAY 2012

Funded by

  • Canadian Institutes of Health Research
  • Canadian Association of Gastroenterology
  • Axcan Pharma

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article with Supporting Information (HTML) Get PDF (229K)

Summary

Background

Clostridium difficile colitis (CDC) is associated with an increased short-term mortality risk in hospitalised ulcerative colitis (UC) patients. We sought to determine whether CDC also impacts long-term risks of adverse health events in this population.

Aim

To determine whether CDC also impacts long-term risks of adverse health events in this population.

Methods

A population-based retrospective cohort study was conducted of UC patients hospitalised in Ontario, Canada between 2002 and 2008. Patients with and without CDC were compared on the rates of adverse health events. The primary outcomes were the 5-year adjusted risks of colectomy and death.

Results

Among 181 patients with CDC and 1835 patients without CDC, the 5-year cumulative colectomy rates were 44% and 33% (P = 0.0052) and the 5-year cumulative mortality rates were 27% and 14% (P < 0.0001) respectively. CDC was associated with a higher adjusted 5-year risk of mortality [adjusted hazard ratio (aHR) 2.40, 95% CI 1.37–4.20], but not of colectomy (aHR 1.18, 95% CI 0.90–1.54). CDC impacted mortality risk both during index hospitalisation (adjusted odds ratio 8.90, 95% CI 2.80–28.3) as well as over 5 years following hospital discharge among patients who recovered from their acute illness (aHR 2.41, 95% CI 1.37–4.22). Colectomy risk was not influenced by CDC in this cohort.

Conclusion

Clostridium difficile colitis is associated with increased short-term and long-term mortality risks among hospitalised ulcerative colitis patients. As colectomy risk is not similarly impacted by Clostridium difficile colitis, factors predictive of death among C. difficile-infected ulcerative colitis patients require elucidation.

View Full Article with Supporting Information (HTML) Get PDF (229K)