Wang Ying, Salmasian Hojjat, Schluger Aaron, Gomez-Simmonds Angela, Choy Alexa, Li Jianhua, Axelrad Jordan E, Freedberg Daniel E
Department of Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Gastro Hep Adv. 2022;1(1):38-44. doi: 10.1016/j.gastha.2021.10.002. Epub 2022 Feb 7.
infection (CDI) is associated with a range of outcomes, and existing prediction models for death among patients with CDI are imprecise. Peripheral eosinopenia has been proposed as a novel risk factor for death among patients with CDI but has not been incorporated into prediction models. This study aimed to develop and validate a prediction model for death among patients hospitalized with CDI that incorporated peripheral eosinopenia.
Eosinopenia was defined as 0 eosinophils/L on the soonest peripheral blood drawn within the 48-hour window of the CDI test (before or after). Adults were eligible for the study if they were hospitalized at any one of 3 large, unaffiliated hospital networks, tested positive for CDI by stool polymerase chain reaction, and received appropriate anti-CDI treatment. Patients were followed for all-cause death for up to 30 days.
There were 4518 unique hospitalized adults with CDI included (2142 in the derivation cohort and 2376 in the validation cohort). All-cause 30-day mortality was 9% and 10% in the cohorts. In the validation cohort, the factors most strongly associated with death were eosinopenia (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 1.77-3.50), albumin <3 g/dL (aOR 3.26, 95% CI 2.13-3.49), and creatinine >1.5 mg/dL (aOR 2.55, 95% CI 1.86-3.49). A 6-variable clinical prediction model was developed that improved on existing classification schemes for CDI severity (area under the receiver operating characteristic curve of 0.75 vs 0.68).
Among adults hospitalized with CDI, peripheral eosinopenia was associated with increased risk of all-cause 30-day mortality. A prediction model incorporating peripheral eosinopenia was developed to improve care for hospitalized patients with CDI through risk stratification.
艰难梭菌感染（CDI）与一系列结局相关，现有的CDI患者死亡预测模型并不精确。外周血嗜酸性粒细胞减少已被提出作为CDI患者死亡的一个新危险因素，但尚未纳入预测模型。本研究旨在开发并验证一个纳入外周血嗜酸性粒细胞减少因素的CDI住院患者死亡预测模型。
嗜酸性粒细胞减少定义为在CDI检测（之前或之后）的48小时窗口期内最早采集的外周血中嗜酸性粒细胞计数为0/μL。如果成年人在3个大型非关联医院网络中的任何一家住院，粪便聚合酶链反应检测CDI呈阳性，并接受了适当的抗CDI治疗，则符合本研究条件。对患者进行长达30天的全因死亡随访。
共纳入4518例CDI住院成年患者（推导队列2142例，验证队列2376例）。队列中的全因30天死亡率分别为9%和10%。在验证队列中，与死亡最密切相关的因素是嗜酸性粒细胞减少（校正比值比[aOR]2.49，95%置信区间[CI]1.77 - 3.50）、白蛋白<3 g/dL（aOR 3.26，95% CI 2.13 - 3.49）和肌酐>1.5 mg/dL（aOR 2.55，95% CI 1.86 - 3.49）。开发了一个6变量临床预测模型，该模型在现有的CDI严重程度分类方案上有所改进（受试者操作特征曲线下面积为0.75，而之前为0.68）。
在CDI住院成年患者中，外周血嗜酸性粒细胞减少与全因30天死亡率增加相关。开发了一个纳入外周血嗜酸性粒细胞减少因素的预测模型，以通过风险分层改善CDI住院患者的护理。
