Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2013 Nov;11(11):1466-71. doi: 10.1016/j.cgh.2013.04.050. Epub 2013 May 20.
BACKGROUND & AIMS: Clostridium difficile infection (CDI) can cause life-threatening complications. Severe-complicated CDI is characterized by hypotension, shock, sepsis, ileus, megacolon, and colon perforation. We created a model to identify clinical factors associated with severe-complicated CDI.
We analyzed data from 1446 inpatient cases of CDI (48.6% female; median age, 62.5 years; range, 0.1-103.7 years) at the Mayo Clinic from June 28, 2007, to June 25, 2010. Patients with severe-complicated CDI (n = 487) were identified as those who required admission to the intensive care unit or colectomy, or died, within 30 days of CDI diagnosis. Logistic regression models were used to identify variables that were independently associated with the occurrence of severe-complicated CDI in 2 cohorts. One cohort comprised all hospitalized patients; the other comprised a subset of these inpatients who were residents of Olmsted County, Minnesota to assess the association of comorbid conditions with the development of severe-complicated infection in a population-based cohort. The linear combinations of variables identified by using logistic regression models provided scores to predict the risk of developing severe-complicated CDI.
In a multivariable model that included all inpatients, increasing age, leukocyte count >15 × 10(9)/L, increase in serum level of creatinine >1.5-fold from baseline, and use of proton pump inhibitors or narcotic medications were independently associated with severe-complicated CDI. In the secondary analysis, which included only patients from Olmsted County, comorbid conditions were not significantly associated with severe-complicated CDI.
Older age, high numbers of leukocytes in blood samples, an increased serum level of creatinine, gastric acid suppression, and use of narcotic medications were independently associated with development of severe-complicated CDI in hospitalized patients. Early aggressive monitoring and intervention could improve outcomes.
艰难梭菌感染（CDI）可导致危及生命的并发症。严重复杂性 CDI 的特征为低血压、休克、败血症、肠梗阻、巨结肠和结肠穿孔。我们创建了一个模型来确定与严重复杂性 CDI 相关的临床因素。
我们分析了 2007 年 6 月 28 日至 2010 年 6 月 25 日梅奥诊所 1446 例住院 CDI 患者（48.6%为女性；中位年龄 62.5 岁；范围 0.1-103.7 岁）的数据。严重复杂性 CDI（n=487）患者定义为 CDI 诊断后 30 天内需入住重症监护病房或接受结肠切除术或死亡的患者。使用逻辑回归模型确定 2 个队列中与严重复杂性 CDI 发生独立相关的变量。一个队列包括所有住院患者；另一个队列包括明尼苏达州奥姆斯特德县的这些住院患者子集，以评估在基于人群的队列中合并症与严重感染发生的相关性。逻辑回归模型确定的变量线性组合提供了预测发生严重复杂性 CDI 的风险评分。
在包括所有住院患者的多变量模型中，年龄增加、白细胞计数＞15×10（9）/L、血清肌酐水平从基线增加 1.5 倍以上、使用质子泵抑制剂或麻醉药物与严重复杂性 CDI 独立相关。在仅包括奥姆斯特德县患者的二次分析中，合并症与严重复杂性 CDI 无显著相关性。
在住院患者中，年龄较大、血液白细胞计数较高、血清肌酐水平升高、胃酸抑制和使用麻醉药物与严重复杂性 CDI 的发生独立相关。早期积极监测和干预可能改善结局。
