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Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study

Introduction: This study primarily sought to evaluate the risk factors for toxic megacolon development and treatment outcomes in Clostridium difficile-positive COVID-19 patients, secondarily to determining predictors of survival. Methods: During the second COVID-19 wave (May 2020 to May 2021), we id...

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Autores principales: Řezáč, Tomáš, Klos, Dušan, Stašek, Martin, Vrba, Radek, Zbořil, Pavel, Špička, Petr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604586/
https://www.ncbi.nlm.nih.gov/pubmed/36294980
http://dx.doi.org/10.3390/life12101545
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author Řezáč, Tomáš
Klos, Dušan
Stašek, Martin
Vrba, Radek
Zbořil, Pavel
Špička, Petr
author_facet Řezáč, Tomáš
Klos, Dušan
Stašek, Martin
Vrba, Radek
Zbořil, Pavel
Špička, Petr
author_sort Řezáč, Tomáš
collection PubMed
description Introduction: This study primarily sought to evaluate the risk factors for toxic megacolon development and treatment outcomes in Clostridium difficile-positive COVID-19 patients, secondarily to determining predictors of survival. Methods: During the second COVID-19 wave (May 2020 to May 2021), we identified 645 patients with confirmed COVID-19 infection, including 160 patients with a severe course in the intensive care unit. We selected patients with Clostridium difficile infection (CDI) (31 patients) and patients with toxic megacolon (9 patients) and analyzed possible risk factors. Results: Patients who developed toxic megacolon had a higher incidence (without statistical significance, due to small sample size) of cancer and chronic obstructive pulmonary disease, a higher proportion of them required antibiotic treatment using cephalosporins or penicillins, and there was a higher rate of extracorporeal circulation usage. C-reactive protein (CRP) and interleukin-6 values showed significant differences between the groups (CRP [median 126 mg/L in the non-toxic megacolon cohort and 237 mg/L in the toxic megacolon cohort; p = 0.037] and interleukin-6 [median 252 ng/L in the group without toxic megacolon and 1127 ng/L in those with toxic megacolon; p = 0.016]). As possible predictors of survival, age, presence of chronic venous insufficiency, cardiac disease, mechanical ventilation, and infection with Candida species were significant for increasing the risk of death, while corticosteroid and cephalosporin treatment and current Klebsiella infection decreased this risk. Conclusions: More than ever, the COVID-19 pandemic required strong up-to-date treatment recommendations to decrease the rate of serious in-hospital complications. Further studies are required to evaluate the interplay between COVID-19 and CDI/toxic megacolon.
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spelling pubmed-96045862022-10-27 Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study Řezáč, Tomáš Klos, Dušan Stašek, Martin Vrba, Radek Zbořil, Pavel Špička, Petr Life (Basel) Article Introduction: This study primarily sought to evaluate the risk factors for toxic megacolon development and treatment outcomes in Clostridium difficile-positive COVID-19 patients, secondarily to determining predictors of survival. Methods: During the second COVID-19 wave (May 2020 to May 2021), we identified 645 patients with confirmed COVID-19 infection, including 160 patients with a severe course in the intensive care unit. We selected patients with Clostridium difficile infection (CDI) (31 patients) and patients with toxic megacolon (9 patients) and analyzed possible risk factors. Results: Patients who developed toxic megacolon had a higher incidence (without statistical significance, due to small sample size) of cancer and chronic obstructive pulmonary disease, a higher proportion of them required antibiotic treatment using cephalosporins or penicillins, and there was a higher rate of extracorporeal circulation usage. C-reactive protein (CRP) and interleukin-6 values showed significant differences between the groups (CRP [median 126 mg/L in the non-toxic megacolon cohort and 237 mg/L in the toxic megacolon cohort; p = 0.037] and interleukin-6 [median 252 ng/L in the group without toxic megacolon and 1127 ng/L in those with toxic megacolon; p = 0.016]). As possible predictors of survival, age, presence of chronic venous insufficiency, cardiac disease, mechanical ventilation, and infection with Candida species were significant for increasing the risk of death, while corticosteroid and cephalosporin treatment and current Klebsiella infection decreased this risk. Conclusions: More than ever, the COVID-19 pandemic required strong up-to-date treatment recommendations to decrease the rate of serious in-hospital complications. Further studies are required to evaluate the interplay between COVID-19 and CDI/toxic megacolon. MDPI 2022-10-05 /pmc/articles/PMC9604586/ /pubmed/36294980 http://dx.doi.org/10.3390/life12101545 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Řezáč, Tomáš
Klos, Dušan
Stašek, Martin
Vrba, Radek
Zbořil, Pavel
Špička, Petr
Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title_full Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title_fullStr Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title_full_unstemmed Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title_short Toxic Megacolon Burdened with COVID-19 Coinfection—Worsening of an Unfavorable Diagnosis: A Single-Center Retrospective Study
title_sort toxic megacolon burdened with covid-19 coinfection—worsening of an unfavorable diagnosis: a single-center retrospective study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604586/
https://www.ncbi.nlm.nih.gov/pubmed/36294980
http://dx.doi.org/10.3390/life12101545
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