Fulminant Clostridium difficile colitis: prospective development of a risk scoring system

Area of Science:

• Infectious Diseases
• Gastroenterology
• Critical Care Medicine

Background:

• Fulminant C. difficile colitis (fCDC) is a severe complication of C. difficile infection, associated with high morbidity and mortality.
• Current clinical practice lacks a rapid tool to identify patients at risk for fCDC and potential surgical intervention.

Purpose of the Study:

• To develop and validate a simple and accurate risk scoring system (RSS) for early identification of patients at risk for fCDC in clinical practice.

Main Methods:

• A prospective study enrolled 746 patients with C. difficile infection.
• Risk factors including age, white blood cell count, cardiorespiratory failure, and abdominal tenderness were identified.
• A multivariable logistic regression model was used to create the RSS, with subsequent calibration and discrimination analysis.

Main Results:

• The RSS incorporates points for age (>70 years), WBC count abnormalities, cardiorespiratory failure, and abdominal tenderness.
• The RSS demonstrated high discriminatory power (c-statistic = 0.98) and good calibration (Hosmer-Lemeshow p=0.78, Brier score=0.019).
• A threshold of 6 points effectively differentiates low-risk from high-risk patients for fCDC.

Conclusions:

• The developed RSS is a valid and reliable bedside tool for identifying patients at risk of developing fCDC.
• External validation is recommended prior to widespread clinical implementation.