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Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection
Jayakrishna Chintanaboina1, Seyedehsan Navabi1, Kristen Suchniak-Mussari1
1From the Department of Gastroenterology, Division of General Internal Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Insights
Advanced age, peptic ulcer disease, Charlson comorbidity index, and ICU status predict 30-day mortality in hospitalized patients with Clostridium difficile infection (CDI). Identifying these factors aids in managing this common nosocomial infection.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- Clostridium difficile infection (CDI) is a leading cause of hospital-acquired infections in the US, costing billions annually.
- Epidemiological shifts in CDI necessitate identifying new risk factors for both initial and recurrent infections.
- Understanding predictors of mortality is crucial for improving patient outcomes and resource allocation.
Purpose of the Study:
- To identify independent predictors of 30-day all-cause mortality in hospitalized patients diagnosed with Clostridium difficile infection.
- To analyze risk factors associated with mortality following an incident CDI diagnosis.
Main Methods:
- Retrospective cohort study of 893 patients diagnosed with CDI between January 2011 and December 2014.
- Data extraction via electronic medical records and chart review.
- Multivariable logistic regression analysis to determine significant predictors of 30-day mortality.
Main Results:
- Of 893 CDI patients, 98 (10.97%) died within 30 days.
- Significant predictors of 30-day mortality included peptic ulcer disease, advanced age, Charlson comorbidity index, and intensive care unit (ICU) status.
- No significant association was found between acid suppression therapy and CDI-related mortality.
Conclusions:
- Advanced age, Charlson comorbidity index, ICU admission, and peptic ulcer disease are key predictors of 30-day mortality in hospitalized CDI patients.
- These findings can inform clinical risk stratification and management strategies for CDI.
- Further research may explore interventions targeting these identified risk factors.
Objectives:
Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of approximately $3 billion. The epidemiology of CDI has changed with the identification of novel risk factors for incident and recurrent CDI. The aim of this study was to identify the predictors of 30-day mortality in hospitalized patients with CDI.
Methods:
We identified all of the patients diagnosed as having CDI from January 2011 to December 2014 at our university-setting hospital. Data were extracted using electronic medical records and chart review. The data of all of the patients who died within 30 days of incident CDI were compared with those who survived beyond 30 days of incident CDI. A multivariable logistic regression model was created for mortality after finding a subset of significant predictor variables by making bivariate comparisons also using logistic regression.
Results:
A total of 893 patients were diagnosed as having CDI during the study period. The mean age was 62 years and 49.5% were women. The mean length of hospital stay was 11.73 days. Of the 893 patients with CDI, 98 (10.97%) died within 30 days of incident CDI. CDI recurrence was noted in 76 patients (8.51%). On multivariate logistic regression analysis, peptic ulcer disease, advanced age, Charlson comorbidity index, and intensive care unit status were found to be significantly associated with 30-day mortality. There was no significant association between acid suppression and CDI mortality.
Conclusions:
Advanced age, Charlson comorbidity index, intensive care unit status, and peptic ulcer disease are predictors of all-cause 30-day mortality in hospitalized patients with CDI.
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