Fulminant Clostridium difficile Infection in Patients Initially Presenting in the Emergency Department: A Retrospective Case Series Analysis: A Proposal for Mortality- Predictive Values Based on the Peak WBC Count and Peak Serum Lactate Level

¹Department of Emergency Medicine, Bayhealth Medical Center, Dover, DE, USA.

²Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, NJ, USA.

³Co-Director, Emergency Medicine Residency, Rowan University SOM.

Corresponding Author: James Espinosa, Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, 18 East Laurel Road, Stratford, NJ 08084, USA. Tel: +1 646 241 5695; E-Mail: [email protected]

 Received Date: 21 Apr 2016  

 Accepted Date: 11 Jul 2016  

 Published Date: 14 Jul 2016

Copyright © 2016 Espinosa J

Citation: Darlington AM, Lucerna A, Espinosa J and Scali V. (2016). Fulminant Clostridium difficile Infection in Patients Initially Presenting in the Emergency Department: A Retrospective Case Series Analysis: A Proposal for Mortality-Predictive Values Based on the Peak WBC Count and Peak Serum Lactate Level. Mathews J Emergency Med. 1(3): 013.

ABSTRACT

Through a retrospective chart review, significant risk factors for morbidity and mortality of patients with fulminant Clostridium difficile colitis were studied.
A presenting or peak white count of less than 16,500 represents lower risk. (p = 0.001). A peak or presenting white count of greater than 30,000 represents the highest risk. (p = 0.001).
A peak lactate of greater than 4 is statistically linked to mortality (p = 0.03) A peak lactate of greater than 5 is even more statistically linked to mortality (p = 0.02).
This study suggests both lactate above 5 and peak white blood cell count above 30,000 have a significant role in predicting mortality from this disease. There is also the suggestion that elevated white blood cell count on presentation may play a role in increased mortality. There are few published studies evaluating elevated lactate and with fulminant C. difficile infection; this could be an area for further investigation.

KEYWORDS

Mortality-Predictive; Clostridium difficile; Emergency Department; Peak Serum Lactate Level.