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Risk predictors of mortality in Clostridium difficile infection

A study in June's issue of the European Journal of Gastroenterology & Hepatology identifies risk factors for mortality in Clostridium difficile infection.

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To date, the vast majority of studies investigating risk factors for mortality in Clostridium difficile infection have been based on retrospective, routinely collected data, and have not specifically tested the capacity of risk factors to predict outcome.

Dr Maxim Bloomfield and colleagues prospectively evaluated predictors of mortality in patients with Clostridium difficile infection, utilizing established metrics of risk prediction to assess their ability to prognosticate.

The team collected a cohort of all patients diagnosed with Clostridium difficile infection at Addenbrooke’s Hospital in 2010.

Univariate associations between several parameters and all-cause 30-day in-hospital mortality were assessed, with statistically significant parameters entered into a Cox regression model.

A backwards selection procedure was used to derive a final multivariate model.

The researchers reported that white blood cell count 15×109/l, serum albumin 25 g/l, serum creatinine 200 μmol/l and C-reactive protein 100 nmol/l met criteria for entry into the multivariate model.

The team found that white blood cell count 15×109/l and serum albumin level 25 g/l, were significantly associated with mortality in the final multivariate model.

White blood cell count of 15×109/l was associated with mortality
European Journal of Gastroenterology & Hepatolology

The doctors noted that the model containing these variables had a C-index of 0.79, D-statistic of 2.1, and R2D measure of 0.52.

Dr Bloomfield's team commented, "We have demonstrated in a prospective cohort of patients diagnosed with Clostridium difficile infection that white blood cells and serum albumin, when used together, offer good risk predictive ability for mortality."

"Our results support the inclusion of these parameters in a clinically useful risk prediction model."

Euro J of Gastroenterol & Hepatol 2013: l25(6): 700-705
14 June 2013

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