An Innovative Severity Score Index for Clostridium difficile Infection

Abstract

Background: Clostridium difficile infection (CDI) accounts for significant inhospital mortality. The purpose of this study was to validate a 9-point severity score index (SSI) at the time of diagnosis that could predict severity and mortality in CDI.Methods: Patients with positive toxin A/B were screened and enrolled within 48 hours of diagnosis. They were categorized based on SSI into mild, moderate, or severe disease. The Charlson Comorbidity Index (CCI) was calculated, and the patients were divided into the following categories: CCI 0, 1, Q 2 or greater. All patients were followed for a period of 90 days.Results: Fifty-four male patients were enrolled (mean age, 76.8 years).Mild, moderate, and severe disease was scored in 63%, 30%, and 7% of the patients, respectively. Low albumin (53.7%) and altered white blood cell count (46.3%) were the most common criteria. Need for intensive care unit care was more frequent with higher SSI (P G 0.05). Mortality rate correlated with disease severity (P = 0.005). The CCI score did not correlate with the severity of CDI; nevertheless, a CCI of 2 or greater had a direct association with overall mortality (P = 0.0001).Discussion: Severity score index measured at the time of diagnosis is a useful tool to assess severity and predict mortality. A high SSI score suggests the need for intensive care unit care in patients with CDI. Subsequent studies are needed to assess if SSI at the time of diagnosis should be used to determine the level of care and treatment strategies that may modify outcomes in this population.

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

“…A nivel mundial, el C. difficile constituye la principal causa de infección intrahospitalaria en los Estados dices que evalúan la severidad de la presentación clínica 15 , lo cual podría ser de gran ayuda en el futuro para categorizar el riesgo y así definir la necesidad de estrategias de tratamiento en esta infección.…”

Derivation and validation of a simple clinical bedside score (ATLAS) for Clostridium difficile infection which predicts response to therapy

“…The six clinical and laboratory parameters used in the analyses were chosen for their ready availability, their ease of calculation, prior correlation with CDI outcome in case series [7-16], and the fact that they had been collected and were available in the two CDI clinical trials of interest. The six parameters, measured on the day of entry into the study (i.e.…”

“…colectomy, need for intensive care, or attributable mortality) or which predicts CDI recurrence. Although several predictive scoring systems and clinical variables have been described in limited CDI populations or case series, none have been validated on large CDI databases [7-16]. While the choice of therapy for malignant neoplasms and subjects with sepsis is often based on validated criteria which consist of both patient and disease-related variables in order to maximize treatment response [17,18], no such validated scheme exists for CDI.…”

Clostridium difficile–Related 30-Day Mortality

“…Toro et al 25 proposed a severity score, including altered WBC count, which could predict severity and mortality in CDI. Toro et al 25 proposed a severity score, including altered WBC count, which could predict severity and mortality in CDI.…”