Leukemoid reactions complicating colitis due to Clostridium difficile

Mark A. Marinella, Steven D. Burdette, Roger Bedimo, Ronald J. Markert

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 × 109/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions. Methods: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 × 10 9/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 × 10 9/L). Results: The mean peak leukocyte count was 52 ± 18.2 × 109/L (± SD) in the case group and 14.9 ± 6.5 × 109/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 × 109/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 × 109/L. Conclusion: Patients with C difficile colitis and a leukocyte count greater than 35 × 109/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.

Original languageEnglish (US)
Pages (from-to)959-963
Number of pages5
JournalSouthern Medical Journal
Volume97
Issue number10
DOIs
StatePublished - Oct 2004

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Leukemoid Reaction
Clostridium difficile
Colitis
Leukocyte Count
Control Groups
Temperature
Mortality
Hematocrit
Serum Albumin
Respiratory Tract Infections
Logistic Models

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Leukemoid reactions complicating colitis due to Clostridium difficile. / Marinella, Mark A.; Burdette, Steven D.; Bedimo, Roger; Markert, Ronald J.

In: Southern Medical Journal, Vol. 97, No. 10, 10.2004, p. 959-963.

Research output: Contribution to journalArticle

Marinella, Mark A. ; Burdette, Steven D. ; Bedimo, Roger ; Markert, Ronald J. / Leukemoid reactions complicating colitis due to Clostridium difficile. In: Southern Medical Journal. 2004 ; Vol. 97, No. 10. pp. 959-963.
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abstract = "Background: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 × 109/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions. Methods: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 × 10 9/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 × 10 9/L). Results: The mean peak leukocyte count was 52 ± 18.2 × 109/L (± SD) in the case group and 14.9 ± 6.5 × 109/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50{\%}) in the leukemoid reaction group and 5 deaths (7.7{\%}) in the control group. All seven patients with a peak leukocyte count greater than 50 × 109/L died, compared with eight deaths (10.3{\%}) among the remaining 78 patients whose peak leukocyte count was less than 50 × 109/L. Conclusion: Patients with C difficile colitis and a leukocyte count greater than 35 × 109/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.",
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N2 - Background: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 × 109/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions. Methods: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 × 10 9/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 × 10 9/L). Results: The mean peak leukocyte count was 52 ± 18.2 × 109/L (± SD) in the case group and 14.9 ± 6.5 × 109/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 × 109/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 × 109/L. Conclusion: Patients with C difficile colitis and a leukocyte count greater than 35 × 109/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.

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