S326 Does Clostridioides Difficile Infection Play a Role in Premalignant Colonic Lesion? A Retrospective Cohort Study
Notice bibliographique
Résumé
Introduction: Clostridioides difficile infection (CDI) and Colorectal Cancer (CRC) are prevalent in the US with CRC carrying a significant mortality risk. However, the link between CDI and colorectal cancer in humans has not been investigated. Prior research only suggests CDI may be linked to tumorigenesis through Wnt signaling and reactive oxygen species induction in mice. This retrospective cohort study aims to investigate the association between CDI and the risk of malignant and premalignant findings on colonoscopy. Methods: Retrospective chart review was conducted at 4 healthcare facilities. Adult patients from Jan 2012 to Dec 2018 were identified using C. difficile test (CDT) reports. Colonoscopy reports at least 5 years after CDT were then compared. The study included 448 charts, with 64 CDT-positive cases. Statistical analyses included Cochran-Mantel-Haenszel Odds Ratios and Type 2 Factorial ANOVA tests to compare observed lesions. The study looked for rates of malignant and premalignant lesions as the primary outcome with overall lesion frequency, size, histology, and ulcerative lesions as secondary outcomes. Results: Group demographics were similar except for smoking status (Table 1). There was no significant difference in the development of polyps and masses between the CDT-positive and CDT-negative patients (OR=1.1; [95% CI 0.7, 2.1]). Both groups had the same median number of polyps (2 [1-3] vs 2 [1-3]; P = 0.79) and polyp size (4mm [2-5.3] vs 4mm [3-6.1]; P = 0.59)). Adenocarcinoma was insufficiently captured for analysis; however, the CDT-positive group had a greater frequency of ulcerative lesions compared to the CDT-negative (OR= 6.149; [95% CI 1.6, 22.65]) (Figure 1). Conclusion: This study explores the potential link between CDI and CRC. Prior human research was limited, making this investigation significant due to CRC's high prevalence. A recent animal study suggested CDI Toxin B could promote tumorigenesis. This study found no significant difference between rates of malignant and premalignant lesions in CDT-positive and negative patients. However, this study demonstrates the potential link between CDI and the risk of developing inflammatory pathologies such as ulcerative colorectal lesions. Limitations include a small sample size and shorter follow-up time than the average polyp-to-cancer progression period. Furthermore, this research could guide future, larger prospective studies that may impact CRC screening for CDI patients.Figure 1.: Forest Plot of Cochran-Mantel-Haenszel OR for lesion observations by subtype. Cochran-Mantel-Haenszel Odds Ratios were used to compare lesion observations between patients with negative and positive CDT while controlling for smoking status. CI (horizontal lines) that include 1 (vertical line) indicate no effect. The lesions with narrower CI represent larger samples with stronger evidence. This Forest Plot shows that only ulcer observations were increased in the CDT-positive compared to the CDT-negative group. There was no effect on the overall observance of any lesion type. OR, odds ratio; CDT, C. difficile tests; CI, confidence interval. Table 1. - Baseline characteristics of the patients CDT-positive Group (n = 64) CDT-negative Group (n = 384) P-value Age at Colonoscopy (median [IQR]) 62.0 [54.3, 69.0] 62.0 [51.8, 69.0] 0.9447 Years between CDT and Colonoscopy (median [IQR]) 6.0 [5.0, 7.0] 6.0 [5.0, 7.0] 0.3273 Sex, Female, n (%) 45 (70.3) 231 (60.2) 0.1592 Race, n (%)WhiteAfrican AmericanAsianOther 26 (40.6)32 (50.0)1 (1.6)5 (7.8) 165 (43.0)206 (53.6)5 (1.3)8 (2.1) 0.0982 Ethnicity, Hispanic, n (%) 1 (1.6) 8 (2.1) 1.0 BMI (median [IQR]) 28.2 [23.4, 33.8] 28.2 [24.4, 33.1] 0.8732 Smoking status, n (%)SmokerNonsmokerEx-smoker 23 (35.9)34 (53.1)7 (10.9) 75 (19.6)204 (53.3)105 (27.3) 0.0197 1 0.0301 Family History of CRC, n (%)First DegreeSecond DegreeNo Family History 2 (3.1)0 (0)62 (96.9) 33 (8.6)10 (2.6)341 (88.8) 0.1522 IBD, n (%)UCCrohn'sNo IBD 1 (1.6)3 (4.7)60 (93.8) 18 (4.7)32 (8.4)334 (87.0) 0.3968 PSC, Yes, n (%) 2 (3.1) 2 (0.5) 0.0996 Comorbidities, Yes, n (%)HTNDMCKDHIV 41 (64.1)19 (29.7)8 (12.5)5 (7.8) 249 (64.8)147 (38.3)68 (17.7)22 (5.7) 1.00.23870.39650.5675 Quality of bowel Preparation, Ottawa Scoring (%)ExcellentGoodFairPoorInadequateNot Mentioned 19 (29.7)32 (50.0)2 (3.1)3 (4.7)4 (6.3)4 (6.3) 75 (19.5)163 (42.4)46 (12.0)20 (5.2)8 (2.1)72 (18.8) 0.06970.278 0.0297 10.077 0.0114 CDT (Clostridioides difficile test), BMI (Body mass index), CRC (colorectal cancer), IBD (inflammatory bowel disease), UC (ulcerative colitis), PSC (primary sclerosing cholangitis), IQR (interquartile range), HTN (hypertension), diabetes mellitus (Diabetes mellitus), CKD (Chronic Kidney disease), HIV (Human immunodeficiency virus).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».