RESUMEN
BACKGROUND: The incidence, recurrence, and all-cause mortality rate for Clostridium difficile-associated diarrhea (CDAD) has increased markedly over the past 10 years despite treatment. Low vitamin D levels are known to impair immune responses to infection and are associated with increased mortality. We compared the role of patient comorbidity measured by the Charlson Comorbidity Index (CCI) with vitamin D levels to ascertain whether vitamin D levels were an independent variable affecting the outcome of CDAD or a marker of overall comorbidity. METHODS: A prospective cohort study studied 62 patients hospitalized between 2008 and 2009 with manifestations of CDAD and a positive C. difficile toxin assay. All patients received standard antibiotics (metronidazole and/or vancomycin). Their status at 30-day follow up was classified as resolved or recurred/expired. Patients' CCI was calculated using their medical history. Logistic regression analysis of variables including 25-hydroxyvitamin D, CCI, age, gender, white blood cell count (WBC), albumin and residence type were performed. RESULTS: There were 62 patients (43.6% men, 56.4% women) with CDAD; mean age was 75 ± 17 years. At 30-day follow up, 28 (45.2%) expired, 10 (16.1%) had persistent or recurrent diarrhea and 24 (38.7%) resolved. Nonresolution was seen in 38 (61.3%). There was no significant association between 30-day resolution status and CCI, gender, WBC, albumin level or residence type. Two variables were found to be independent predictors of resolution of CDAD: normal vitamin D levels (p = 0.028) and age <70 years (p = 0.024). Subjects with low vitamin D were 4.75 times more likely to fail to resolve CDAD than subjects with normal Vitamin D. CONCLUSION: In this study, vitamin D level and age are independent predictors of CDAD resolution in hospitalized patients. Low vitamin D levels and age >70 years old are associated with increased likelihood of recurrence. Low vitamin D levels are not a marker of comorbidity or advanced age.
RESUMEN
BACKGROUND: Use of antiplatelet agents (APAs) have been shown to increase the risk of gastrointestinal (GI) bleeding despite their cardiovascular benefits. AIM: To understand the impact of APAs, we assessed the outcomes in patients admitted with acute GI bleeding to our hospital. We hypothesized there is no difference among GI bleeders admitted to the hospital while bleeding on or off APAs. METHODS: In an observational prospective cohort study, 104 sequential patients admitted with a diagnosis of GI bleeding were followed. Patients were classified as either on APA or not. RESULTS: Thirty of 104 (29%) patients were on long-term aspirin and/or clopidogrel on admission and 5 were taking nonaspirin nonsteroidal anti-inflammatory drugs, total of 35 (34%). There was no difference between patients using APA and those not using APA with regard to admission hemoglobin, age, presentation, source of bleed, total number of units transfused, intensive care unit admission rates, and overall length of stay. There was, however, a significant difference in the presence of hemodynamic compromise on initial presentation, with a higher proportion of APA users being orthostatic (51.4% vs 26% in nonusers, with P=0.02, by Fisher exact test). Clopidogrel was safely restarted in high-risk patients with significant cardiac history. CONCLUSIONS: This study demonstrated that APA use did not significantly alter the course or outcome in GI bleeders admitted to our institution during their hospital stay.