Development and validation of a simple and robust model to predict 30-day mortality in patients with Clostridioides difficile-associated enterocolitis.
OBJECTIVE
Clostridioides difficile infection (CDI) is a common healthcare-associated infection and associated with high morbidity and mortality. As current guidelines recommend treatment stratified for disease severity, this study aimed to identify predictors of 30-day mortality in order to develop a robust prediction model.


DESIGN
This was a retrospective analysis of 207 inpatients with CDI who were treated at the Jena University Hospital between September 2011 and December 2015. In a training cohort (n=127), predictors of 30-day mortality were identified by receiver operating characteristics analysis and logistic regression. The derived model was validated in an independent cohort of 80 inpatients with CDI.


RESULTS
Within 30 days, 35 (28%) patients in the training cohort died from any cause. C-reactive protein (CRP) of ≥121 mg/L (OR 3.80; 95% CI 1.64 to 7.80; p=0.003) and lower systolic blood pressure of ≤104 mm Hg (OR 3.73; 95% CI 1.63 to 8.53; p=0.002) at diagnosis as well as development of renal impairment (serum creatinine >1.5×baseline; OR 5.61; 95% CI 1.94 to 16.26; p=0.035) within the first 6 days were associated with 30-day mortality in univariate analysis. The use of these parameters enabled correct mortality prediction in 73% of cases on the day of diagnosis and in 76% at day 6. In the validation cohort, 30-day mortality was 18/80 (23%). Our model enabled a 73.7% correct prediction concerning 30-day mortality on day 6 after diagnosis of CDI.


CONCLUSION
Hypotension and CRP elevation on the day of diagnosis as well as occurrence of kidney dysfunction during the first 6 days are suitable parameters to predict 30-day mortality in patients with CDI who need to be treated in the hospital.
['Katzer|Katrin Claudia|KC|0000-0003-1136-0784', 'Hagel|Stefan|S|', 'Reuken|Philipp Alexander|PA|', 'Bruns|Tony|T|', 'Stallmach|Andreas|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D002097:C-Reactive Protein D000082682:Clostridioides D003015:Clostridium Infections D003428:Cross Infection D004760:Enterocolitis D005260:Female D006801:Humans D007022:Hypotension D016015:Logistic Models D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011379:Prognosis D012372:ROC Curve D051437:Renal Insufficiency D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index
infectious diarrhoea infectious disease infective colitis