Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection

摘要

Background Clostridium difficile infection poses a significant healthcare burden. However, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described. This study aimed to identify such a prediction rule to stratify hospital inpatients according to risk of all-cause mortality, at initial diagnosis of infection. Method Univariate, multivariate and decision tree procedures were used to deduce a prediction rule from over 186 variables; retrospectively collated from clinical data for 213 patients. The resulting prediction rule was validated on independent data from a cohort of 158 patients described by Bhangu et al. (Colorectal Disease, 12(3):241-246, 2010). Results Serum albumin levels (g/L) (P?=?0.001), respiratory rate (resps /min) (P?=?0.002), C-reactive protein (mg/L) (P?=?0.034) and white cell count (mcL) (P?=?0.049) were predictors of all-cause mortality. Threshold levels of serum albumin?≤?24.5?g/L, C- reactive protein >228?mg/L, respiratory rate >17 resps/min and white cell count >12?×?103 mcL were associated with an increased risk of all-cause mortality. A simple four variable prediction rule was devised based on these threshold levels and when tested on the initial data, yield an area under the curve score of 0.754 (P? Conclusions Four easily measurable clinical variables can be used to assess the risk of mortality of patients with Clostridium difficile infection and remains robust with respect to independent data.