Cheng Ting Lin, Presenter: Nothing to Disclose

Anil Balani, Abstract Co-Author: Nothing to Disclose

Eugene Im, Abstract Co-Author: Nothing to Disclose

Simcha Pollack, Abstract Co-Author: Nothing to Disclose

James Grendell, Abstract Co-Author: Nothing to Disclose

Douglas Scott Katz MD, Abstract Co-Author: Nothing to Disclose

To evaluate the role of CT in determining prognosis in Clostridium difficile-associated disease (CDAD) by correlating specific CT findings with patient outcomes including ICU admission, colectomy, & mortality. 

We retrospectively analyzed 106 consecutive inpatients who had a CT of the abdomen & pelvis performed within 7 days of a positive C. difficile toxin assay, between 1/05 & 11/06.  Clinical & laboratory parameters were reviewed.  CT scans were retrospectively reviewed by a single experienced radiologist, who was blinded to the CT reports & specific patient information & outcomes.  The presence or absence of the following were recorded: colitis (& distribution); "accordion sign"; submucosal edema; pericolonic stranding; bowel dilatation; ascites; & pleural effusion.  Colitis, stranding, dilatation, ascites, & effusion extent were graded as mild, moderate, or marked.  Statistical analyses, including logistic regression, were performed. 

Eighty patients (75%) showed CT evidence of colitis.  The majority had pancolitis (58/80 [73%]).  Other CT findings included the accordion sign (29[36%]), pericolonic stranding {75[94%]), submucosal edema (53[66%]), ascites (23[29%]), colonic dilatation (61[76%]), & pleural effusion (41[51%]).  Fifteen patients (15%) required ICU monitoring because of CDAD.  Eight (8%) required colectomy.  Mortality from CDAD was recorded for 10 patients (9%), & overall mortality was 20%.  Ascites on CT correlated with the need for ICU monitoring (p < 0.001).  The association between a positive accordion sign as well as pleural effusions, & the need for ICU monitoring, approached statistical significance.  Logistic regression analysis showed that the combination of clinical presentation (diarrhea, abdominal pain, nausea/vomiting, & fever) with laboratory values (WBC count, HCO3, BUN, Cr) at the time of CDAD diagnosis & the presence of ascites on CT have predictive value for the need for ICU monitoring (p < 0.002). 

The majority of patients with CDAD had CT evidence of collitis, mostly pancolitis.  Ascites on CT was independently correlated to the need for ICU monitoring. 

There may be predictive value in grouping clinical presentation, initial lab values, & ascites on CT for determining prognosis in CDAD.

Lin, C, Balani, A, Im, E, Pollack, S, Grendell, J, Katz, D, Clostridium Difficile Diarrhea and Colitis in an Inpatient Population: Value of CT in Establishing Prognosis.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6009590.html