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.
Dr. Burgess and her colleagues conducted a case-control chart review of 181 adult patients with confirmed C. difficile colitis. Of these patients, 55 received corticosteroid medications for the treatment of other medical conditions, and 126 did not receive corticosteroids.
The mortality rate was significantly higher in the corticosteroid group, compared with the group not treated with these drugs (40% vs. 15%), as was the colectomy rate (16% vs. 3%), said 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 patients (25%) in the control group, she said.
“In our study, we could not explain [the differences] by other patient characteristics or comorbidity,” Dr. Burgess explained.
Patients who developed severe outcomes were generally older, but this was true in both groups. Although serum albumin concentrations were lower in patients who required a colectomy or who died, there was no significant difference in albumin levels between those who did and those who did not receive corticosteroids.
Also, there were greater proportions of women, patients with chronic obstructive pulmonary disease, and patients with heart failure in the corticosteroid group, but this did not appear to influence the risk for severe outcomes, Dr. Burgess said.
The findings suggest that a host immune response to corticosteroids may increase the risk of poor outcomes in patients with severe C. difficile infection.
Additional studies to confirm these results are warranted, Dr. Burgess concluded.