OBJECTIVE

To perform a comparative analysis of surgical and conservative treatment of pseudomembranous colitis (PMC) and to identify risk factors associated with the need for surgical intervention.

MATERIAL AND METHODS

The study was conducted at the Loginov Moscow Clinical Scientific and Practical Center between 2017 and 2023. A total of 67 patients with clinically confirmed severe and fulminant PMC were included. Surgical treatment was performed in 11 patients, while 56 patients received conservative therapy. Clinical, endoscopic, and laboratory parameters, as well as the incidence of complications, were analyzed. Multivariate analysis with odds ratio (OR) estimation was used to identify risk factors for surgical intervention, followed by the development of a prognostic model.

RESULTS

Patients who underwent surgical treatment more frequently presented with fever (p=0.001; OR=8.821; 95% CI 2.039—38.162), stool frequency ≥10 times per day (p=0.045), and hematochezia (p=0.004; OR=6.944; 95% CI 1.616—29.841). Endoscopic examination more often revealed contact bleeding of the colonic mucosa (p=0.032; OR=4.622; 95% CI 1.062—20.127) and difficulty in pseudomembrane fragmentation (p=0.046). Among complications, colonic bleeding (p<0.001; OR=31.429; 95% CI 3.063—322.434) and colonic dilatation (p=0.016; OR=12.222; 95% CI 1.001—149.161) were significantly more common in surgically treated patients. Preoperative red blood cell transfusion was performed more frequently in the surgical group (45.5% vs 10.7%; p=0.004). The prognostic model demonstrated high diagnostic accuracy (AUC=0.916; p<0.001), with a sensitivity of 97.6% and specificity of 63.6%.

CONCLUSIONS

Risk factors for surgical intervention in PMC include hematochezia, fever at hospital admission, contact bleeding of the colonic mucosa, development of colonic bleeding, colonic dilatation, and the need for red blood cell transfusion.