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Novel severity score shows promise in predicting in-hospital C. difficile mortality
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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 (CDI)]-associated in-hospital mortality, our study aimed to develop and validate an objectively derived severity score to predict CDI-associated mortality using a large administrative database,” Ashwin N. Ananthakrishnan, MBBS, MPH, assistant professor of medicine at Harvard Medical School and Massachusetts General Hospital, and colleagues wrote.
Using data from the U.S. 2011 Nationwide Inpatient Sample (NIS), the research team identified 77,776 CDI hospitalizations, which corresponded to approximately 374,747 CDI cases nationally, of which 8% were associated with in-hospital mortality. The researchers conducted multivariate analysis to identify eight predictors of CDI-associated in-hospital mortality:
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 CDI hospitalizations from the 2010 NIS database, corresponding to 335,963 CDI 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 CDI-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
- Reference:
- Kassam Z, et al. Aliment Pharmacol Ther. 2016;doi:10.1111/apt.13546.
Disclosure: Ananthakrishnan reports being supported in part by an NIH grant. Please see the full study for a list of all other authors’ relevant financial disclosures.