Henrich Timothy J, Krakower Douglas, Bitton Asaf, Yokoe Deborah S
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Emerg Infect Dis. 2009 Mar;15(3):415-22. doi: 10.3201/eid1503.080312.
Identifying patients who are at high risk for severe Clostridium difficile-associated disease (CDAD) early in the course of their infection may help clinicians improve outcomes. Therefore, we compared clinical features associated with severe versus nonsevere CDAD by retrospectively reviewing records of hospitalized patients whose fecal assays were positive for C. difficile toxin. Of 336 patients, 12.2% had severe disease and 10.1% died from all causes. Regression modeling showed the following to be significantly associated with severe CDAD (p< or =0.05): age >70 years (odds ratio [OR] 3.35), maximum leukocyte count >20,000 cells/mL (OR 2.77), minimum albumin level <2.5 g/dL (OR 3.44), maximum creatinine level >2 mg/dL (OR 2.47), small bowel obstruction or ileus (OR 3.06), and computed tomography scan showing colorectal inflammation (OR 13.54). These clinical and laboratory markers for severe disease may be useful for identifying patients at risk for serious outcomes or death.
在感染初期识别出患有严重艰难梭菌相关性疾病（CDAD）的高危患者，可能有助于临床医生改善治疗效果。因此，我们通过回顾性分析粪便检测艰难梭菌毒素呈阳性的住院患者记录，比较了与严重CDAD和非严重CDAD相关的临床特征。在336例患者中，12.2%患有严重疾病，10.1%死于各种原因。回归模型显示，以下因素与严重CDAD显著相关（p≤0.05）：年龄>70岁（比值比[OR]3.35）、白细胞最高计数>20,000个/毫升（OR 2.77）、白蛋白最低水平<2.5克/分升（OR 3.44）、肌酐最高水平>2毫克/分升（OR 2.47）、小肠梗阻或肠梗阻（OR 3.06）以及计算机断层扫描显示结肠直肠炎症（OR 13.54）。这些严重疾病的临床和实验室指标可能有助于识别有严重后果或死亡风险的患者。
