A Prediction Model of Disease Severity in Clostridium difficile -Associated Disease

Im, Gene Y.; Modayil, Rani J.; Feuerman, Martin; Lin, Cheng Ting; Balani, Anil R.; Katz, Douglas S.; Grendell, James H.

doi:10.1016/s0016-5085(11)61474-1

Cited by 3 publications

(3 citation statements)

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“…In Lungulescu's study [30] , 29% of severe cases had a score ≥2 among four possible criteria. On the other hand, with only two clinical parameters (WCC and BUN), Im [31] predicted 50% of the risk of mortality, and with >2 among 7 criteria Belmares [20] predicted only 67% of treatment failures.…”

Section: Resultsmentioning

confidence: 94%

Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review

2012

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ContextIdentifying patients at risk for adverse outcomes of Clostridium difficile infection (CDI), including recurrence and death, will become increasingly important as novel therapies emerge, which are more effective than traditional approaches but very expensive. Clinical prediction rules (CPRs) can improve the accuracy of medical decision-making. Several CPRs have been developed for CDI, but none has gained a widespread acceptance.MethodsWe systematically reviewed studies describing the derivation or validation of CPRs for unfavourable outcomes of CDI, in medical databases (Medline, Embase, PubMed, Web of Science and Cochrane) and abstracts of conferences.ResultsOf 2945 titles and abstracts screened, 13 studies on the derivation of a CPR were identified: two on recurrences, five on complications (including mortality), five on mortality alone and one on response to treatment. Two studies on the validation of different severity indices were also retrieved. Most CPRs were developed as secondary analyses using cohorts assembled for other purposes. CPRs presented several methodological limitations that could explain their limited use in clinical practice. Except for leukocytosis, albumin and age, there was much heterogeneity in the variables used, and most studies were limited by small sample sizes. Eight models used a retrospective design. Only four studies reported the incidence of the outcome of interest, even if this is essential to evaluate the potential usefulness of a model in other populations. Only five studies performed multivariate analyses to adjust for confounders.ConclusionsThe lack of weighing variables, of validation, calibration and measures of reproducibility, the weak validities and performances when assessed, and the absence of sensitivity analyses, all led to suboptimal quality and debatable utility of those CPRs. Evidence-based tools developed through appropriate prospective cohorts would be more valuable for clinicians than empirically-developed CPRs.

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Section: Resultsmentioning

confidence: 94%

Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review

2012

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“…Leukocytosis is incriminated not only in Alexey Markelov's studies [15,21] but also in those of Bhangu S. or Im G.Y. [17,22]. Hypoalbuminemia occurs as a variable associated with increased risk of mortality in several articles in recent years [10,17,21].…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases

Laza

Jurac²,

Crişan

et al. 2015

BMC Infect Dis

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Background: The recent emergence of Clostridium difficile infections has included this condition among top nosocomial infections, due to its incidence, complications and important fatality, as well as to significant economic costs. Methods: A prospective surveillance study of Clostridium difficile enterocolitis cases was performed in "Victor Babeş" Infectious Diseases Hospital in Timişoara (Romania) between 01.01.2013 -30.06.2014, to estimate the incidence and to investigate the risk factors for unfavourable outcome and relapse. Dichotomous variables were compared by the chi-square test or Fisher exact test and the Mann-Whitney U test was used for continuous variables. Risk factors for unfavourable outcome/recurrence were investigated by logistic regression. Results: 210 patients who experienced 219 episodes of infection with Clostridium difficile were identified, which gives an incidence per hospital of 20.57/15.70 to 1,000 discharged patients in 2013/2014 or 17.73/14.04 to 10,000 patientdays. In 162 patients (77.14%) the evolution was favourable while in 48 (22.86%) the outcome was unfavourable. In 42 patients (20.00%) recurrence of symptoms was identified. The multivariate analysis by logistic regression identified the ATLAS score (OR = 4.97, 95% CI = 2.12 to 11.66, p <0.001), age (OR = 1.12, 95% CI = 1.00 to 1.25, p = 0.046), and the number of antibiotics after episode onset (OR = 2.692, 95% CI = 1.01 to 7.17, p = 0.047) as predictors of an unfavourable evolution, while the number of hospitalization days (OR = 1.10, 95% CI = 1.03 to 1.16, p = 0.0015) was associated with recurrence of symptoms.

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“…A variety of published outcome models ( Table 1 ) have been derived within small populations (e.g., Belmares et al, 102 patients at 1 hospital) ( 8 ), utilize trial cohorts with exclusion criteria that limit generalizability (e.g., ATLAS) ( 9 ), use variables occurring after severe outcomes have begun to develop (e.g., Im et al, imaging findings up to a week after diagnosis) ( 10 ), and/or were calibrated to predict outcome measures that are nonspecific to CDI (e.g., Kulaylat et al, all-cause mortality ( 1 )). The few models that are validated at multiple institutions do not perform well on external validation ( 11 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Validation of Clinical Risk Models for Clostridioides difficile - Attributable Outcomes

Madden

Petri

Costa

et al. 2022

Antimicrob Agents Chemother

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A Prediction Model of Disease Severity in Clostridium difficile -Associated Disease

Cited by 3 publications

References 0 publications

Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review

Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review

Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases

Validation of Clinical Risk Models for Clostridioides difficile - Attributable Outcomes

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