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A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection
BACKGROUND AND AIMS: Clostridioides difficile 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 inc...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377641/ https://www.ncbi.nlm.nih.gov/pubmed/35974881 http://dx.doi.org/10.1016/j.gastha.2021.10.002 |
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author | Wang, Ying Salmasian, Hojjat Schluger, Aaron Gomez-Simmonds, Angela Choy, Alexa Li, Jianhua Axelrad, Jordan E. Freedberg, Daniel E. |
author_facet | Wang, Ying Salmasian, Hojjat Schluger, Aaron Gomez-Simmonds, Angela Choy, Alexa Li, Jianhua Axelrad, Jordan E. Freedberg, Daniel E. |
author_sort | Wang, Ying |
collection | PubMed |
description | BACKGROUND AND AIMS: Clostridioides difficile 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. METHODS: Eosinopenia was defined as 0 eosinophils/μL 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. RESULTS: 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). CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-9377641 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
record_format | MEDLINE/PubMed |
spelling | pubmed-93776412022-08-15 A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection Wang, Ying Salmasian, Hojjat Schluger, Aaron Gomez-Simmonds, Angela Choy, Alexa Li, Jianhua Axelrad, Jordan E. Freedberg, Daniel E. Gastro Hep Adv Article BACKGROUND AND AIMS: Clostridioides difficile 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. METHODS: Eosinopenia was defined as 0 eosinophils/μL 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. RESULTS: 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). CONCLUSION: 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. 2022 2022-02-07 /pmc/articles/PMC9377641/ /pubmed/35974881 http://dx.doi.org/10.1016/j.gastha.2021.10.002 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). |
spellingShingle | Article Wang, Ying Salmasian, Hojjat Schluger, Aaron Gomez-Simmonds, Angela Choy, Alexa Li, Jianhua Axelrad, Jordan E. Freedberg, Daniel E. A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title_full | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title_fullStr | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title_full_unstemmed | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title_short | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
title_sort | prediction model incorporating peripheral eosinopenia as a novel risk factor for death after hospitalization for clostridioides difficile infection |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377641/ https://www.ncbi.nlm.nih.gov/pubmed/35974881 http://dx.doi.org/10.1016/j.gastha.2021.10.002 |
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