S326 Does Clostridioides Difficile Infection Play a Role in Premalignant Colonic Lesion? A Retrospective Cohort Study
Bibliographic record
Abstract
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).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".