Efficacy of Computed Tomography for the Prediction of Colectomy and Mortality in Patients with Clostridium difficile InfectionEfficacy of Computed Tomography for the Prediction of Colectomy and Mortality in Patients with Clostridium difficile Infection

Background: CT parameters have been proposed as predictors of severity and complicated C. difficile colitis. However, none has succeeded in adding a predictive value to CT findings on top of other clinical predictors of complicated CDI. We sought to develop a CT predictor scale for the need for colectomy and to evaluate predictors of all-cause mortality within 30 days after diagnosis of C. difficile infection (CDI).

Methods: We conducted a retrospective study of adult hospitalized patients who underwent abdominal CT within 72 h of CDI diagnosis.

Results: Presence of abnormal wall thickening in caecum (OR 8.0; CI 1.37-46.81; p=0.021), transverse colon (OR 6.7; CI 1.15-35.60; p=0.034), sigmoid colon (OR 12.6; CI 1.37-115.97; p=0.025), pancolitis (OR 7.0; CI 1.36-36.01; p=0.02) and bowel dilation (OR 16.5; CI 2.41-112.83; p=0.004) predicted colectomy. With these values, a five parameter radiological scale from 0-24 was developed (sensitivity and NPV of 100%, cut-off of 6). Furthermore, wall thickening of caecum (OR 6.2; CI 1.06-35.57; p=0.043), ascending colon (OR 12.0; CI 1.29-111.32; p=0.029), descending colon (OR 17.0; CI 1.81-160.05; p=0.013) and sigmoid (OR 10.2; CI 1.10-94.10; p=0.041) independently predicted mortality within 30 days of CDI diagnosis. Patients with 0-6 points did not undergo colectomy and survived for more than 30 days.

Conclusion: We designed a CT scale to predict colectomy able to rule out the development of fulminant colitis and the need for surgical procedure. Patients with wall thickening of the caecum, ascending, descending or sigmoid colon were more likely to die within 30 days of CDI diagnosis.

Table 1. Monterrey CT scale to predict fulminant colitis and colectomy in patients with Clostridium difficile infection

Parameter	Assigned score
Increased caecum wall thickness >3 mm	4
Increased transverse colon wall thickness >3 mm	3
Increased sigmoid colon wall thickness >3 mm	6
Pancolitis	3
Bowel dilation	8
Totala	24

^a Positive score is greater or equal to 6.

Figure 1, Table 2.

Figure 1, Table 2. Area under the curve under the receiver operator curve (AROC) was generated to determine the cut-off, obtaining an area under the curve of 0.867 (CI 0.744-.990; p=0.001). The cut-off defined for the scale was ≥6.