Patti Giulia, Veronese Nicola, De Gennaro Nicolò, De Vita Elda, Papagni Roberta, Pellegrino Carmen, Amendolara Angela, Guerra Vittorio, Vigna Alessandra, Spada Vito, Cormio Mariangela, Cassano Domenica, Metrangolo Giuliana, Ronga Luigi, Chironna Maria, Stolfa Stefania, Di Gennaro Francesco, Saracino Annalisa
Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, Bari 70124, Italy.
Faculty of Medicine, Saint Camillus International University of Health Sciences, Rome, Italy.
JAC Antimicrob Resist. 2025 Aug 8;7(4):dlaf143. doi: 10.1093/jacamr/dlaf143. eCollection 2025 Aug.
infection (CDI) is considered one of the most significant healthcare-associated infections with significant morbidity and mortality. Frailty, characterized by diminished physiological reserves, has emerged as a critical determinant of poor outcomes. The Frailty Index based on Laboratory tests (FI-Lab), derived from routine laboratory parameters, offers an objective tool for assessing frailty. The primary aim of this study was to assess the efficacy of FI-Lab in predicting mortality and recurrence in CDI hospitalized patients.
This retrospective study analysed data from 280 patients diagnosed with CDI, hospitalized at the Policlinic of Bari between 2020 and 2024. Frailty was assessed using FI-Lab, based on 35 routine laboratory tests. Primary outcomes included 14- and 28-day mortality, recurrence during hospitalization and recurrence post-discharge. Associations between FI-Lab and outcomes were evaluated.
Of the 280 patients included, 213 survived and 67 died during hospitalization or within 28 days post-infection. Non-survivors had significantly higher FI-Lab scores compared to survivors (0.70 ± 0.15 versus 0.25 ± 0.12, < 0.0001). FI-Lab demonstrated excellent discrimination for mortality at 14 and 28 days, with each 0.10-point increase in FI-Lab associated with elevated mortality risk. Predictive accuracy for recurrence was moderate (AUC = 0.73 for recurrence within 60 days post-discharge). Fidaxomicin use did not significantly reduce mortality or recurrence after adjustment for FI-Lab and comorbidities.
FI-Lab is a predictor of mortality in CDI patients and a valuable tool for early risk stratification. Its utility in predicting recurrences is limited. Prospective studies are warranted to validate these findings and refine therapeutic approaches for high-risk patients.
艰难梭菌感染（CDI）被认为是最严重的医疗相关感染之一，具有较高的发病率和死亡率。以生理储备减少为特征的衰弱已成为不良预后的关键决定因素。基于实验室检查的衰弱指数（FI-Lab）由常规实验室参数得出，为评估衰弱提供了一种客观工具。本研究的主要目的是评估FI-Lab在预测CDI住院患者死亡率和复发率方面的有效性。
这项回顾性研究分析了2020年至2024年期间在巴里综合医院住院的280例诊断为CDI患者的数据。基于35项常规实验室检查，使用FI-Lab评估衰弱情况。主要结局包括14天和28天死亡率、住院期间复发率和出院后复发率。评估FI-Lab与结局之间的关联。
纳入的280例患者中，213例存活，67例在住院期间或感染后28天内死亡。与幸存者相比，非幸存者的FI-Lab评分显著更高（0.70±0.15对0.25±0.12，<0.0001）。FI-Lab在14天和28天死亡率方面具有出色的辨别能力，FI-Lab每增加0.10分，死亡风险就会升高。复发的预测准确性中等（出院后60天内复发的AUC = 0.73）。在对FI-Lab和合并症进行调整后，使用非达霉素并未显著降低死亡率或复发率。
FI-Lab是CDI患者死亡率的预测指标，也是早期风险分层的有价值工具。其在预测复发方面的效用有限。有必要进行前瞻性研究以验证这些发现并完善高危患者的治疗方法。
