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Elevated Amylase in Clostridium difficile–Associated Diarrhea: A Case Report and Follow-Up Retrospective Study

Vahora, Ilyas MD*; Lee, Winston MD; Rai, Anand MD*; Fein, Elie MD; Sharma, Kavita MD; Janga, K. C. MD, FACP; Greenberg, Sheldon MD

Infectious Diseases in Clinical Practice: January 2013 - Volume 21 - Issue 1 - p 25–27
doi: 10.1097/IPC.0b013e31826babd8
Original Articles

Background Clostridium difficile–associated diarrhea (CDAD) is associated with high morbidity and mortality. There are several risk factors that have been identified that are linked to worsening outcomes including age of the patient, length of hospitalization, comorbidities, use of certain high-risk antibiotics, and more recently renal insufficiency. At our institution, we recently identified a patient with recurrent CDAD with elevated amylase level. More impressively, his level of amylase followed the course of his infection and returned to normal during his remission state. We proposed an association between C. difficile infection and amylase level.

Methods We enrolled 726 patients who were 18 years or older, who had a history of CDAD and positive C. difficile toxin at time of diagnosis and had a measurement of amylase level within 3 days of toxin positivity. Patients were excluded if amylase levels were measured 3 days before or 3 days after C. difficile toxin positivity or were younger than 18 years. This study was retrospective in design. We also gathered other laboratory data such as basic metabolic panel, complete blood count, liver function test, lipase, length of hospital stay, and patient outcome of those who met the inclusion criteria. The primary outcome was death during hospitalization, and secondary outcome was length of stay. We also did a subset analysis looking at variables such as age, sex, albumin, renal insufficiency, anemia, amylase level, and leukocytosis and its association with C. difficile.

Results A total of 726 cases of CDAD were identified. Overall hospital mortality was 26.6%, and mean length of stay was 25.3 days. When analyzing with logistic regression, only increasing age (odds ratio, 1.08; P < 0.001), increased creatinine (odds ratio, 1.50; P = 0.003), and decreased albumin (odds ratio, 0.19; P = 0.001) were associated with increased in-hospital mortality. All other factors including sex, white blood count, hemoglobin, and amylase did not show any change in mortality.

Conclusions Based on this retrospective study, we were unable to identify any relationship between amylase level and CDAD. Secondary outcomes from the analysis revealed that whereas increasing age, decreased albumin, and renal insufficiency put one at risk for C. difficile infection, other factors such as sex, anemia, leukocytosis, and amylase level cannot be used to risk stratify patients.

From the *Internal Medicine and Divisions of †Nephrology and ‡Infectious Disease, Maimonides Medical Center, Brooklyn, NY.

Correspondence to: K. C. Janga, MD, FACP, Division of Nephrology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2013 Lippincott Williams & Wilkins, Inc.