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Published on: December 10, 2016
High Horn's index score predicts poor outcomes in patients with Clostridium difficile infection
V Arora1, S Kachroo, S S Ghantoji
1University of Houston College of Pharmacy, Houston, TX, USA.
Insights
Horn's index effectively identifies patients with Clostridium difficile infection (CDI) at high risk for poor outcomes. This simple score helps predict mortality, hospital costs, and length of stay for CDI patients.
Area of Science:
- Infectious Diseases
- Clinical Epidemiology
- Health Economics
Background:
- Predicting prognosis in Clostridium difficile infection (CDI) is crucial for patient management and resource allocation.
- Existing prognostic tools lack clinical utility for stratifying resource utilization in CDI patients.
- Horn's index, a score based on underlying clinical illness, has shown promise in identifying high-risk CDI patients.
Purpose of the Study:
- To evaluate Horn's index for stratifying hospitalized patients with CDI based on their risk of adverse clinical and economic outcomes.
- To assess the correlation between Horn's index scores and key outcome variables including mortality, length of hospital stay, and hospital costs.
Main Methods:
- Prospective cohort study of hospitalized patients diagnosed with CDI.
- Calculation of Horn's index scores for each patient on the day of positive C. difficile toxin test.
- Stratification of patients by Horn's index score (1-4) to analyze differences in outcome variables over a three-month follow-up period.
Main Results:
- Discharge mortality rates increased significantly with higher Horn's index scores (0% for scores 1-2, 5% for score 3, 50% for score 4; P < 0.001).
- Three-month mortality and median hospital costs showed a clear dose-response relationship with Horn's index scores (P = 0.0004 and P < 0.001, respectively).
- Patients with Horn's index scores of 3 or 4 experienced significantly longer hospital stays compared to those with scores of 1 or 2 (mean 33.4 vs. 15.1 days; P = 0.001).
Conclusions:
- Horn's index is a simple, reliable, and clinically useful tool for identifying patients with Clostridium difficile infection at high risk of poor clinical and economic outcomes.
- The index facilitates risk stratification, enabling targeted resource utilization and management strategies for CDI patients.
- Application of Horn's index can aid healthcare providers in anticipating patient trajectories and associated healthcare costs.
Abstract:
Several variables have been proposed to predict the prognosis of patients with Clostridium difficile infection (CDI), but a clinically useful tool to stratify resource utilization has not been determined. Horn's index, a severity score based on underlying clinical illness, reliably predicts patients at high risk of CDI. The purpose of this study was to assess the use of Horn's index to stratify patients with CDI at high risk of poor clinical and economic outcomes. Hospitalized patients diagnosed with CDI were followed prospectively for three months. Horn's index scores were calculated for each patient on the day of the positive toxin test for C. difficile, and used to stratify differences in outcome variables (length of hospital stay, mortality and hospital costs). Eighty-five CDI patients (50% male, 64% Caucasian) were recruited. Discharge mortality was 0% for patients with Horn's index scores of 1 or 2, 5% for those with a score of 3, and 50% for those with a score of 4 (P < 0.001). Three-month mortality was 0%, 5%, 17% and 60% for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P = 0.0004). Median three-month hospital costs were $8,585, $12,670, $29,077 and $68,708 for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P < 0.001). Patients with Horn's index scores of 3 or 4 had a significantly longer hospital stay [mean 33.4 (standard deviation, SD 33.3) days] than patients with scores of 1 or 2 [mean 15.1 (SD 16.2) days, P = 0.001]. This study found Horn's index to be a simple and useful method for identifying CDI patients at high risk of poor clinical and economic outcomes.
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