María E Negrón1,2, Ali Rezaie3, Herman W Barkema2, Kevin Rioux4, Jeroen De Buck2, Sylvia Checkley5, Paul L Beck4, Matthew Carroll6, Richard N Fedorak7, Levinus Dieleman7, Remo Panaccione4, Subrata Ghosh4, Gilaad G Kaplan1,4. 1. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Departments of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 5. Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada. 6. Department of Pediatrics, University of Alberta. 7. Department of Medicine, Division of Gastroenterology & Nutrition, University of Alberta, Edmonton, Alberta, Canada.
Abstract
OBJECTIVES: Clostridium difficile (C. difficile) may worsen the prognosis of ulcerative colitis (UC). The objectives of this study were to: (i) validate the International Classification of Diseases-10 (ICD-10) code for C. difficile; (ii) determine the risk of C. difficile infection after diagnosis of UC; (iii) evaluate the effect of C. difficile infection on the risk of colectomy; and (iv) assess the association between C. difficile and postoperative complications. METHODS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing ICD-10 codes for C. difficile with stool toxin tests. A population-based surveillance cohort of newly diagnosed UC patients living in Alberta, Canada were identified from 2003 to 2009 (n=1,754). The effect of a C. difficile infection on colectomy was modeled using competing risk survival regression after adjusting for covariates. The effect of a C. difficile infection on postoperative complications was assessed using a mixed effects logistic regression model. RESULTS: The sensitivity, specificity, PPV, and NPV of the ICD-10 code for C. difficile were 82.1%, 99.4%, 88.4%, and 99.1%, respectively. The risk of C. difficile infection within 5 years of diagnosis with UC was 3.4% (95% confidence interval (CI): 2.5-4.6%). The risk of colectomy was higher among UC patients diagnosed with C. difficile (sub-hazard ratio (sHR)=2.36; 95% CI: 1.47-3.80). C. difficile increased the risk of postoperative complications (odds ratio=4.84; 95% CI: 1.28-18.35). C. difficile was associated with mortality (sHR=2.56 times; 95% CI: 1.28-5.10). CONCLUSIONS: C. difficile diagnosis worsens the prognosis of newly diagnosed patients with UC by increasing the risk of colectomy, postoperative complications, and death.
OBJECTIVES:Clostridium difficile (C. difficile) may worsen the prognosis of ulcerative colitis (UC). The objectives of this study were to: (i) validate the International Classification of Diseases-10 (ICD-10) code for C. difficile; (ii) determine the risk of C. difficileinfection after diagnosis of UC; (iii) evaluate the effect of C. difficileinfection on the risk of colectomy; and (iv) assess the association between C. difficile and postoperative complications. METHODS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by comparing ICD-10 codes for C. difficile with stool toxin tests. A population-based surveillance cohort of newly diagnosed UC patients living in Alberta, Canada were identified from 2003 to 2009 (n=1,754). The effect of a C. difficileinfection on colectomy was modeled using competing risk survival regression after adjusting for covariates. The effect of a C. difficileinfection on postoperative complications was assessed using a mixed effects logistic regression model. RESULTS: The sensitivity, specificity, PPV, and NPV of the ICD-10 code for C. difficile were 82.1%, 99.4%, 88.4%, and 99.1%, respectively. The risk of C. difficileinfection within 5 years of diagnosis with UC was 3.4% (95% confidence interval (CI): 2.5-4.6%). The risk of colectomy was higher among UC patients diagnosed with C. difficile (sub-hazard ratio (sHR)=2.36; 95% CI: 1.47-3.80). C. difficile increased the risk of postoperative complications (odds ratio=4.84; 95% CI: 1.28-18.35). C. difficile was associated with mortality (sHR=2.56 times; 95% CI: 1.28-5.10). CONCLUSIONS:C. difficile diagnosis worsens the prognosis of newly diagnosed patients with UC by increasing the risk of colectomy, postoperative complications, and death.
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