Risk prediction for 30-day mortality among patients with Clostridium difficile infections: a retrospective cohort study

Abstract

BackgroundCurrent guidelines have unsatisfied performance in predicting severe outcomes after Clostridium difficile infection (CDI). Our objectives were to develop a risk prediction model for 30-day mortality and to examine its performance among inpatients with CDI.MethodsThis retrospective cohort study was conducted at China Medical University Hospital, a 2111-bed tertiary medical center in central Taiwan. We included adult inpatients who had a first positive C. difficile culture or toxin assay and had diarrhea as the study population. The main exposure of interest was the biochemical profiles of white blood cell count, serum creatinine (SCr), estimated glomerular filtration rate, blood urea nitrogen (BUN), serum albumin, and glucose. The primary outcome was the 30-day all-cause mortality and the secondary outcome was the length of stay in the intensive care units (ICU) following CDI. A multivariable Cox model and a logistic regression model were developed using clinically relevant and statistically significant variables for 30-day mortality and for length of ICU stay, respectively. A risk scoring system was established by standardizing the coefficients. We compared the performance of our models and the guidelines.ResultsOf 401 patients, 23.4% died within 30 days. In the multivariable model, malignancy (hazard ratio [HR] = 1.95), ≥ 1.5-fold rise in SCr (HR = 2.27), BUN-to-SCr ratio > 20 (HR = 2.04), and increased glucose (≥ 193 vs < 142 mg/dL, HR = 2.18) were significant predictors of 30-day mortality. For patients who survived the first 30 days of CDI, BUN-to-SCr ratio > 20 (Odds ratio [OR] = 4.01) was the only significant predictor for prolonged (> 9 days) length of ICU stay following CDI. The Harrell’s c statistic of our Cox model for 30-day mortality (0.727) was significantly superior to those of SHEA-IDSA 2010 (0.645), SHEA-IDSA 2018 (0.591), and ECSMID (0.650). Similarly, the conventional c statistic of our logistic regression model for prolonged ICU stay (0.737) was significantly superior to that of the guidelines (SHEA-IDSA 2010, c = 0.600; SHEA-IDSA 2018, c = 0.634; ESCMID, c = 0.645). Our risk prediction scoring system for 30-day mortality correctly reclassified 20.7, 32.1, and 47.9% of patients, respectively.ConclusionsOur model that included novel biomarkers of BUN-to-SCr ratio and glucose have a higher predictive performance of 30-day mortality and prolonged ICU stay following CDI than do the guidelines.

Validation of the SHEA/IDSA severity criteria to predict poor outcomes among inpatients and outpatients with Clostridioides difficile infection

“…38,39 More recently, both versions of the SHEA/ IDSA criteria were validated for the prediction of 30-day mortality in a tertiary-care facility in China among a small number of CDI patients (n = 401) with AUCs between 0.60 and 0.65. 40 We similarly observed that both criteria exhibited poor discrimination (ie, AUCs near 0.60) and low positive predictive values (ie, PPVs near 0.30) in both the acute-care and subacute-care settings. Overall model metrics provide further evidence of suboptimal performance.…”

Clinical Characteristics of Patients with Clostridium Difficile Infection and Its Relationship with Fecal Occult Blood Test

“…In the study conducted in Asian pacific countries, 60-day mortality in CDI patients was found to be 5.2% (Collins et al, 2020). In the study conducted in Taiwan, 30-day mortality was found to be 23.4%; and the presence of malignancy, high glucose level, 1.5-fold increase in serum creatinine were determined as independent risk factors affecting mortality (Chiang et al, 2019). Chopra et al found that, the presence of a history of malignancy or organ transplant, a history of hospitalization in the last 60 days, long-term antibiotherapy, presence of nasogastric tube or parenteral nutrition and rectal enema were found as risk factors determining the 30-day mortality (Chopra et al, 2016).…”

Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers

“…Finally, we have previously tested the device’s sensitivity and specificity in a range of laboratory and clinical conditions. 24 …”

“…Overall sensitivity and specificity of this novel electronic wearable device (to correctly identify a HH action) were 94.1% (95% CI, 91.4%-96.2%) and 99.0% (95% CI, 97.5%-99.7%), respectively. 24 …”