Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Minerva Med. 2021 Feb;112(1):124-129. doi: 10.23736/S0026-4806.20.07139-6. Epub 2020 Nov 18.
Clostridium difficile infection (CDI)-associated mortality is a major global health concern. Several clinical and laboratory parameters have been linked to poor prognosis in patients with CDI. In the current study, we aimed to assess the rate of in-hospital mortality among Israeli CDI patients and to look for clinical and laboratory parameters associated to death.
We performed a multicenter retrospective study enrolling all patients above 18-years old who were hospitalized for CDI or with diagnosis made during hospitalization in two regional, teaching hospitals in the north of Israel (Galilee Medical Center, Nahariya and the Nazareth Hospital, Nazareth, Israel), from January 1, 2015 until January 1, 2020. All files of eligible patients were reviewed for demographic (age, gender), medical history and laboratory tests.
Overall, we included in the study 180 patients, among them 56 died in hospital due to CDI (group A) while 124 survived (group B). The average age in groups A and B was 77.02±13 vs. 71.5±19.1, respectively. On univariate analysis, several clinical and laboratory parameters were associated with in-hospital mortality, including: advanced age, renal failure, antibiotics treatment while on treatment for CDI, need for mechanical ventilation, level of hemoglobin, white blood cells (WBC) and neutrophils count, neutrophil/lymphocyte ratio, serum level of albumin, creatinine and C reactive protein. On multivariate logistic regression analysis, only 4 parameters showed statistically significant association with in-hospital mortality, including age (odds ratio [OR]: 6.97, 95%confidence interval [CI]: 4.94-8.72, P=0.003), renal failure (OR: 3.72, 95% CI: 1.22-11.24, P=0.02), WBC count (OR: 1.09, 95% CI: 1.02-1.16, P=0.008), and lower albumin level (OR: 47.62, 95% CI: 10.31-200, P<0.0001).
In this retrospective, multicenter study, age, serum albumin level, leucocytes count, and renal failure were the main predictors of in-hospital mortality in patients with CDI. Thus, antibiotic use should be weighed carefully in elderly comorbid patients, at increased risk of mortality from CDI .Prospective multicenter randomized studies investigating the effect of albumin infusion on in-hospital death of CDI patients are needed, thus enabling us to direct monitoring and treatment accordingly.
艰难梭菌感染（CDI）相关死亡率是一个主要的全球健康问题。一些临床和实验室参数与 CDI 患者的不良预后相关。在本研究中，我们旨在评估以色列 CDI 患者的住院死亡率，并寻找与死亡相关的临床和实验室参数。
我们进行了一项多中心回顾性研究，纳入了 2015 年 1 月 1 日至 2020 年 1 月 1 日期间在以色列北部两家地区性教学医院（加利利医疗中心，纳哈里亚和拿撒勒医院，拿撒勒，以色列）因 CDI 住院或在住院期间确诊的所有 18 岁以上患者。对符合条件的患者的所有档案进行了回顾，包括人口统计学（年龄、性别）、病史和实验室检查。
总体而言，我们纳入了 180 名患者，其中 56 名因 CDI 住院死亡（A 组），124 名存活（B 组）。A 组和 B 组的平均年龄分别为 77.02±13 岁和 71.5±19.1 岁。单因素分析显示，几项临床和实验室参数与住院死亡率相关，包括：年龄较大、肾功能衰竭、CDI 治疗期间接受抗生素治疗、需要机械通气、血红蛋白、白细胞（WBC）和中性粒细胞计数、中性粒细胞/淋巴细胞比值、血清白蛋白、肌酐和 C 反应蛋白水平。多变量逻辑回归分析显示，只有 4 个参数与住院死亡率有统计学显著关联，包括年龄（比值比[OR]：6.97，95%置信区间[CI]：4.94-8.72，P=0.003）、肾功能衰竭（OR：3.72，95%CI：1.22-11.24，P=0.02）、白细胞计数（OR：1.09，95%CI：1.02-1.16，P=0.008）和较低的白蛋白水平（OR：47.62，95%CI：10.31-200，P<0.0001）。
在这项回顾性多中心研究中，年龄、血清白蛋白水平、白细胞计数和肾功能衰竭是 CDI 患者住院死亡率的主要预测因素。因此，在老年合并症患者中，应谨慎权衡抗生素的使用，这些患者的 CDI 死亡率风险较高。需要进行前瞻性多中心随机研究，以调查白蛋白输注对 CDI 患者住院死亡的影响，从而能够进行相应的监测和治疗。
