Development and validation of a simple and robust model to predict 30-day mortality in patients with Clostridioides difficile-associated enterocolitis

BMJ Open Gastroenterology, vol. 7, pp. e000468

Abstract

OBJECTIVE: 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.

Authors 5

1. Katrin Katzer corresponding

   Jena University Hospital

   Affiliation as printed

   Department of Internal Medicine IV, Jena University Hospital, Jena, Germany

2. Stefan Hagel

   Jena University Hospital

   Affiliation as printed

   Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany

3. Philipp Alexander Reuken

   Jena University Hospital

   Affiliation as printed

   Department of Internal Medicine IV, Jena University Hospital, Jena, Germany

4. Tony Bruns Aachen Medical Department III

   RWTH Aachen University · Jena University Hospital

   Affiliation as printed

   Department of Internal Medicine IV, Jena University Hospital, Jena, Germany

   Medical Department III, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany

5. Andreas Stallmach

   Jena University Hospital

   Affiliation as printed

   Department of Internal Medicine IV, Jena University Hospital, Jena, Germany