ORLANDO, FLA. — Corticosteroid use may increase the risk of complications leading to colectomy and death in patients with Clostridium difficile colitis, Sherri L. Burgess, M.D., said at the annual meeting of the American College of Gastroenterology.
In a case-control chart review of 181 adult patients with confirmed C. difficile colitis, 55 patients were treated with corticosteroids for the treatment of other medical problems, and 126 patients did not receive corticosteroids. Mortality was significantly higher in the corticosteroid group (40% vs. 15%), as was the colectomy rate (16% vs. 3%), reported Dr. Burgess of St. Vincent Charity Hospital, Cleveland.
Furthermore, six of nine patients (67%) who underwent colectomy in the corticosteroid group died, compared with one of four (25%) in the control group, she said.
“In our study, we could not explain [the differences] by other patient characteristics or comorbidity,” she said.
Patients who developed severe outcomes were generally older, but this was true in both groups, and although serum albumin levels were lower in patients who required a colectomy or who died, there was no significant difference in the levels between those who did and those who did not receive corticosteroids.
Also, the greater proportions of women, patients with chronic obstructive pulmonary disease, and patients with heart failure in the corticosteroid group did not appear to affect severe outcome, Dr. Burgess said.
The findings suggest that a host immune response to corticosteroids may be a detrimental factor in patients with severe C. difficile. Additional studies are warranted, she concluded.