Univariate and multivariate analysis of risk factors for severe clostridium difficile -associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

Hardt, Christian; Berns, T.; Treder, W.; Dumoulin, Franz Ludwig

doi:10.3748/wjg.14.4338

Cited by 47 publications

(34 citation statements)

References 29 publications

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“…The CCI had been used by some clinical researchers to evaluate the effect that comorbidities have in mortality, LOS, and as a risk to develop CDI. 8,17 In our study, the role of medical comorbidities in the CDI-related mortality, when stratified in severity groups, showed no correlation.…”

Section: Discussioncontrasting

confidence: 54%

An Innovative Severity Score Index for Clostridium difficile Infection

Toro

Amaral-Mojica

Rocha-Rodriguez

et al. 2011

Infectious Diseases in Clinical Practice

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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.

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Section: Discussioncontrasting

confidence: 54%

An Innovative Severity Score Index for Clostridium difficile Infection

Toro

Amaral-Mojica

Rocha-Rodriguez

et al. 2011

Infectious Diseases in Clinical Practice

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“…4 A case control study of CDI in hip fracture patients showed a 10% excess death rate at 30 days that increased to 38% at 6 months. 5 In an attempt to analyse risk factors for severe CDI Hardt et al 6 found an overall mortality of 10% at 30 days. A 6-month prospective surveillance study of 6 Canadian provinces in 2004e2005 detected 1430 cases of hospital acquired CDI with 31 directly and 53 indirectly related deaths giving an overall attributable mortality of 5.7% at 3 months.…”

Section: Resultsmentioning

confidence: 99%

A review of mortality due to Clostridium difficile infection

Karas¹,

Enoch²,

Aliyu³

2010

Journal of Infection

127

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“…13 We believe that this may be especially true in patients who are already leukopenic at the time of CDI diagnosis and are thus unable to mount an adequate reactive leukocytosis in response to infection.…”

Section: Discussionmentioning

confidence: 97%

Laboratory Markers as Predictors of Mortality in Patients with Clostridium difficile Infection

Pant

Madonia

Minocha

et al. 2010

Journal of Investigative Medicine

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Previous studies have identified laboratory markers for severe Clostridium difficile infection (CDI). The most consistent of these markers is the presence of marked leukocytosis. We examined the validity of these markers as predictors of mortality in patients with CDI. We excluded patients with preexisting hematologic conditions that would be expected to impair their ability to demonstrate leukocytosis. On univariate analysis, marked leukocytosis (P = 0.02), thrombocytopenia (P = 0.008), and increased blood urea nitrogen (P < 0.001) and creatinine (P = 0.001) levels were found to be significantly associated with mortality in patients with CDI. However, on logistic regression analysis, only renal impairment was found to be an independent predictor (odds ratio, 5.07). Importantly, in our study, leukocytosis was not an independent predictor after adjustment for other variables, which may be due to our selection criteria when adjusting for confounding variables. We are therefore of the opinion that in immunocompromised hosts who are leukopenic at the time of CDI diagnosis, other laboratory markers should be identified to serve as indicators for severe disease.

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Univariate and multivariate analysis of risk factors for severe clostridium difficile -associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

Abstract: Patients with a severe level of co-morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.

Cited by 47 publications

References 29 publications

An Innovative Severity Score Index for Clostridium difficile Infection

An Innovative Severity Score Index for Clostridium difficile Infection

A review of mortality due to Clostridium difficile infection

Laboratory Markers as Predictors of Mortality in Patients with Clostridium difficile Infection

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