Warning Signs for Fulminant Progression of Clostridioides difficile Infection in Hospitalized Patients: A Scoping Review

Abstract

Clostridioides difficile infection may progress to fulminant disease characterized by shock, paralytic ileus, and toxic megacolon. Early recognition of this progression remains a clinical challenge, particularly in hospitalized patients presenting with atypical manifestations or nonspecific signs of deterioration. This scoping review aims to map the evidence on clinical, laboratory, and radiological findings associated with progression to fulminant C. difficile infection. Searches will be conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and LILACS, including relevant observational studies, case series, and case reports. Data will be extracted on clinical manifestations, leukocytosis, creatinine, lactate, albumin, radiological findings, therapeutic interventions, and clinical outcomes. Findings will be synthesized descriptively, taking into account study heterogeneity and limitations in the severity criteria used. The review is expected to identify major warning signs, assess the limitations of available parameters, and characterize knowledge gaps concerning the prediction of clinical deterioration. This synthesis may help improve the recognition of high-risk patients and inform future research on early assessment strategies.