Ahmad Omar, Crawford Timothy N, Arora Vaneet, Maskey Mitu Karki
Division of Infectious Diseases, University of Kentucky, 740 S. Limestone Street K512, Lexington, 40536, KY, USA.
Department of Population and Public Health Sciences, Wright State University, 3123 Research Boulevard, Dayton, 45420, OH, USA.
Infect Prev Pract. 2021 Feb 15;3(2):100127. doi: 10.1016/j.infpip.2021.100127. eCollection 2021 Jun.
Old age, leucocytosis, hypoalbuminemia, and elevated creatinine have been identified as risk factors for fulminant infection (CDI). High ATLAS scores have also been linked to fatal disease. The affiliated studies, however, involved patients prescribed metronidazole - a regimen no longer standard of care. The variables were thus reassessed in patients prescribed optimal therapy.
Adults hospitalized with CDI at University of Kentucky Medical Center were retrospectively reviewed. Enrolled subjects were separated according to disease classification i.e. non-severe/severe versus fulminant CDI. Fulminant patients were further subdivided into hypotensive persons responsive to fluid resuscitation, and those with sequent shock, ileus, or megacolon. Following partition, the cohorts underwent correlation analysis.
Forty-five subjects had non-severe/severe disease. Thirteen fulminant CDI patients responded to fluid resuscitation. Seventeen fulminant CDI patients developed shock, ileus, or megacolon. Median WBC counts, albumin values, and ATLAS scores varied among the cohorts. Although WBC counts were similar among the fulminant subsets, declining albumin values and increasing ATLAS scores mirrored disease worsening. Logistic regression revealed albumin values < 20 g/L (odds ratio [OR] 3.91) and ATLAS scores ≥ 6 (OR 5.03) to predict critical illness in hypotensive persons.
Median WBC counts, albumin values, and ATLAS scores differed in patients separated by CDI severity. A notable variance in albumin values and ATLAS scores between fluid responsive fulminant disease and critical illness was moreover seen. The finding suggests hypoalbuminemia and high ATLAS scores in hypotensive CDI patients may herald shock, ileus, or megacolon.
老年、白细胞增多、低白蛋白血症和肌酐升高已被确定为暴发性感染（艰难梭菌感染）的危险因素。高ATLAS评分也与致命疾病有关。然而，相关研究涉及使用甲硝唑治疗的患者——这一治疗方案已不再是标准治疗方案。因此，对接受最佳治疗的患者的这些变量进行了重新评估。
对肯塔基大学医学中心因艰难梭菌感染住院的成人患者进行回顾性研究。根据疾病分类，即非重度/重度与暴发性艰难梭菌感染，将入选患者分开。暴发性感染患者进一步细分为对液体复苏有反应的低血压患者，以及出现继发性休克、肠梗阻或巨结肠的患者。分组后，对这些队列进行相关性分析。
45名患者患有非重度/重度疾病。13名暴发性艰难梭菌感染患者对液体复苏有反应。17名暴发性艰难梭菌感染患者出现休克、肠梗阻或巨结肠。各队列的白细胞计数中位数、白蛋白值和ATLAS评分各不相同。虽然暴发性感染亚组的白细胞计数相似，但白蛋白值下降和ATLAS评分升高反映了疾病的恶化。逻辑回归显示，白蛋白值<20 g/L（比值比[OR] 3.91）和ATLAS评分≥6（OR 5.03）可预测低血压患者的危重病。
根据艰难梭菌感染严重程度分组的患者，其白细胞计数中位数、白蛋白值和ATLAS评分存在差异。此外，在对液体有反应的暴发性疾病和危重病之间，白蛋白值和ATLAS评分存在显著差异。这一发现表明，低血压艰难梭菌感染患者的低白蛋白血症和高ATLAS评分可能预示着休克、肠梗阻或巨结肠。
