Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity

Abstract

Purpose Clostridioides difficile infection (CDI) has a high mortality among older patients. Identification of older patients with CDI in increased mortality risk is important to target treatment and thereby reduce mortality. The aim of this study was to investigate mortality rates and compare frailty levels at discharge, measured by the record-based Multidimensional Prognostic Index (MPI), with age and severity of CDI as mortality predictors in patients with CDI diagnosed during hospitalisation. Methods This was a population-based cohort study from Central Denmark Region, Denmark, including all patients ≥ 60 years with a positive CD toxin test without prior infection and diagnosed from 1 January to 31 December 2018. Frailty level, estimated from the electronic medical record, was defined as low, moderate, or severe frailty. CDI severity was graded according to international guidelines. Primary outcome was 90-day mortality. Results We included 457 patients with median age 77 years (interquartile range 69–84) and females (49%). Overall, 90-day mortality was 28%, and this was associated with age (hazard ratio (HR): 2.71 (95% confidence interval 1.64–4.47)), CDI severity (HR 4.58 (3.04–6.88)) and frailty (HR 10.15 (4.06–25.36)). Frailty was a better predictor of 90-day mortality than both age (p < 0.001) and CDI severity (p = 0.04) with a receiver operating characteristic curve area of 77%. Conclusion The 90-day mortality among older patients with CDI in a Danish region is 28%. Frailty measured by record-based MPI at discharge outperforms age and disease severity markers in predicting mortality in older patients with CDI.

The Hospital Frailty Risk Score as a Useful Inpatient Prognostic tool for Clostridioides difficile infections: A Nationwide Assessment

“…[27][28][29][30][31] The concept of frailty as a predictor of mortality is established, however, data in CDI remain limited. [32][33][34][35] In our study, we found that frail individuals (e.g., intermediate and high HFRS) were at a 4-7-fold increased mortality. Although a cumulative de cit frailty index for older individuals hospitalized with CDI has been developed (e.g., the Frailty Index for Clostridium di cile (FI-CDI)), it has not been validated for use in patients < 55 years of age (19).…”

Frailty is a predictor for worse outcomes in patients hospitalized with Clostridioides difficile infection

“…A recent Danish study of 457 elderly patients (≥60 years) with first-time CDI found that those with severe levels of frailty (measured by a multidimensional prognostic index based on clinical assessment tools) were 10 times more likely to die within 90 days than those with low frailty levels, after adjustment for age and sex (hazard ratio [HR] 10.2, 95%CI 4.1-25.4; P<0.001). Frailty was a better predictor of mortality than both age (P<0.001) and CDI severity (defined as albumin <30 g/L, leucocytes >15×10 9 /L, or abdominal pain) (P=0.04) with a receiver operating characteristic curve area of 77% [ 19 ].…”