Healio
Healio
March 09, 2016
2 min read
Save

Novel severity score shows promise in predicting in-hospital C. difficile mortality

The Clostridium difficile-associated risk of death score, or CARDS, shows promise as a tool for predicting mortality among hospitalized patients with C. difficile infection, according to recent study data.

“Given the paucity of a robust severity scoring system to predict [C. difficile infection]-associated in-hospital mortality, our study aimed to develop and validate an objectively derived severity score to predict [C. difficile infection]-associated mortality using a large administrative database,” Zain Kassam, MD, MPH, from the Massachusetts Institute of Technology and chief medical officer for OpenBiome, Ashwin N. Ananthakrishnan, MBBS, MPH, from Harvard Medical School and Massachusetts General Hospital, and colleagues wrote.

Ashwin N. Ananthakrishnan

Zain Kassam

Using data from the U.S. 2011 Nationwide Inpatient Sample (NIS), the research team identified 77,776 C. difficile infection hospitalizations, which corresponded to approximately 374,747 C. difficile infection cases nationally, of which 8% were associated with in-hospital mortality. Multivariate analysis was used to identify eight predictors of C. difficile infection-associated in-hospital mortality:

  • increasing age (81-100 years vs. 18-40 years; OR = 4.12; 95% CI, 3.39-4.99);
  • ICU admission (OR = 5.29; 95% CI, 4.85-5.77);
  • acute renal failure (OR = 2.93; 95% CI, 2.76-3.13);
  • liver disease (OR = 2; 95% CI, 1.78-2.25);
  • malignancy (OR = 1.89; 95% CI, 1.74-2.05);
  • inflammatory bowel disease (OR = 1.72; 95% CI, 1.49-1.99);
  • cardiopulmonary disease (OR = 1.46; 95% CI, 1.38-1.56); and
  • diabetes (decreased risk; OR = 0.83; 95% CI, 0.77-0.88).

The CARDS score was calculated based on the cumulative, rounded weights of each independent predictive variable, ranging from zero to 18 points in the study cohort. Mortality increased significantly as CARDS increased, ranging from 1.2% for a zero score to 100% for a score of 18.

The performance of CARDS was validated in an independent sample of 67,715 C. difficile infection hospitalizations from the 2010 NIS database, corresponding to 335,963 C. difficile infection hospitalizations nationally. The performance was found to be comparable, with a C-statistic of 0.77.

“To our knowledge, CARDS is the first objectively derived severity score to predict [C. difficile infection]-associated mortality using a national administrative database,” the researchers concluded. “Although validation in other cohorts is needed, this simple severity improves generalizability and is a promising tool for epidemiologists and clinicians.” – by Adam Leitenberger

Disclosure: Kassam reports he was supported by a Harvard University fellowship, and Ananthakrishnan reports he is supported in part by an NIH grant.

Sources/Disclosures

Collapse
Source:

Kassam Z, et al. Aliment Pharmacol Ther. 2016;doi:10.1111/apt.13546.