Risk Estimation for Recurrent Clostridium Difficile Infection Based on Clinical Factors.
Clin Infect Dis. 2014 Mar 5;
Authors: D'Agostino RB, Collins SH, Pencina KM, Kean Y, Gorbach S
Background. The incidence of Clostridium difficile infection (CDI) has risen dramatically during the last decade. Although patients respond well to medical therapy such as vancomycin, 20-30% of patients treated suffer a recurrence of CDI. Methods. We developed a simple/practical scoring rule (logistic regression model) for recurrent CDI using data from two large Phase 3 clinical trials (www.clinicaltrials.gov: study NCT00314951 and study NCT00468728). 77 baseline CDI factors were classified: demographics, co-morbidity, medications, vital signs, laboratory tests, severity and symptoms. Predictors with the highest discrimination in each class (using Receiver Operating Characteristics Curve) were selected. For the final model, stepwise selection was performed. Discrimination, calibration and internal validation were used to assess the model. Results. The final model with a simple scoring rule was developed. It includes four independent risk factors which are readily available when the patient makes initial contact: age (<75 vs. ≥75years), number of unformed bowel movements during previous 24 hours (<10 vs. ≥10), serum creatinine levels (<1.2 mg/dL, ≥1.2 mg/dL) and prior episode of CDI (yes vs. no). In addition, the model includes choice of treatment (vancomycin or fidaxomicin). Conclusions. The prediction model for recurrence may be useful for treatment decision.
PMID: 24599770 [PubMed - as supplied by publisher]