IDEAS Center of Innovation, Veterans' Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Infect Control Hosp Epidemiol. 2020 May;41(5):510-516. doi: 10.1017/ice.2020.8. Epub 2020 Jan 30.
To determine whether the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Clostridioides difficile infection (CDI) severity criteria adequately predicts poor outcomes.
Retrospective validation study.
Patients with CDI in the Veterans’ Affairs Health System from January 1, 2006, to December 31, 2016.
For the 2010 criteria, patients with leukocytosis or a serum creatinine (SCr) value ≥1.5 times the baseline were classified as severe. For the 2018 criteria, patients with leukocytosis or a SCr value ≥1.5 mg/dL were classified as severe. Poor outcomes were defined as hospital or intensive care admission within 7 days of diagnosis, colectomy within 14 days, or 30-day all-cause mortality; they were modeled as a function of the 2010 and 2018 criteria separately using logistic regression.
We analyzed data from 86,112 episodes of CDI. Severity was unclassifiable in a large proportion of episodes diagnosed in subacute care (2010, 58.8%; 2018, 49.2%). Sensitivity ranged from 0.48 for subacute care using 2010 criteria to 0.73 for acute care using 2018 criteria. Areas under the curve were poor and similar (0.60 for subacute care and 0.57 for acute care) for both versions, but negative predictive values were >0.80.
Model performances across care settings and criteria versions were generally poor but had reasonably high negative predictive value. Many patients in the subacute-care setting, an increasing fraction of CDI cases, could not be classified. More work is needed to develop criteria to identify patients at risk of poor outcomes.
确定美国医疗保健流行病学学会（SHEA）和美国传染病学会（IDSA）艰难梭菌感染（CDI）严重程度标准是否能充分预测不良结局。
回顾性验证研究。
2006 年 1 月 1 日至 2016 年 12 月 31 日期间退伍军人事务部医疗系统中患有 CDI 的患者。
对于 2010 年的标准，白细胞增多或血清肌酐（SCr）值≥基线的 1.5 倍被归类为严重。对于 2018 年的标准，白细胞增多或 SCr 值≥1.5mg/dL 的患者被归类为严重。不良结局定义为诊断后 7 天内住院或入住重症监护病房、14 天内行结肠切除术或 30 天全因死亡率；使用逻辑回归分别将其作为 2010 年和 2018 年标准的函数进行建模。
我们分析了 86112 例 CDI 发作的数据。在亚急性护理中诊断的大部分发作中，严重程度无法分类（2010 年为 58.8%，2018 年为 49.2%）。使用 2010 年标准时，亚急性护理的敏感性范围为 0.48，而使用 2018 年标准时急性护理的敏感性为 0.73。两种版本的曲线下面积都较差且相似（亚急性护理为 0.60，急性护理为 0.57），但阴性预测值均>0.80。
在不同护理环境和标准版本下，模型性能总体较差，但阴性预测值较高。亚急性护理环境中的许多患者，即越来越多的 CDI 病例，无法进行分类。需要做更多的工作来制定标准，以识别有不良结局风险的患者。
