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Comparison of Clinical Severity Score Indices for Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Shigeki Fujitani ,
W. Lance George  and
A. Rekha Murthy
Shigeki Fujitani*
Affiliation:
Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, Kawasaki, Japan
W. Lance George
Affiliation:
Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
A. Rekha Murthy
Affiliation:
University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California Department of Hospital Epidemiology, Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California
*
St. Marianna University Hospital, 2-16-1 Sugao Miyamae-ku, Kawasaki-city, Kanagawa, Japan2168511 ([email protected])
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Abstract

Objective.

To compare 8 severity score indices for Clostridium difficile infection (CDI).

Design.

Prospective observational study.

Methods.

This study was conducted from July through October 2006. All hospitalized patients in 3 university-affiliated hospitals with a positive fecal Clostridium difficile toxin assay result were evaluated. Infection was considered severe if patients had at least 1 of the following clinical events during their hospitalization: (1) death attributed to CDI within 30 days after diagnosis, (2) colectomy necessitated by CDI, or (3) intensive care unit admission for management of complications attributed to CDI. Severity was assessed on the basis of 8 severity score indices, using published criteria for severe CDI as the benchmark. The 8 severity score indices studied were Beth Israel, University of Pittsburgh Medical Center version 1, University of Pittsburgh Medical Center version 2, Hines VA, modified University of Illinois, University of Calgary version 1, University of Calgary version 2, and University of Temple.

Results.

Of 184 patients with CDI evaluated, 19 had severe cases and 165 had nonsevere cases, as assessed on the basis of the defined severe CDI criteria. Sensitivities of the 8 severity score indices studied ranged from 63.2% to 84.2%, and specificities ranged from 59.4% to 93.9%. The Hines VA index had the highest kappa score (0.69 [95% confidence interval, 0.54-0.83]), followed by the University of Pittsburgh Medical Center version 1 index. Independent risk factors for severe CDI determined by multivariate analysis were abdominal distention (P = .007), fever (temperature, 38.0°C or above; P = .042), white blood cell count of at least 20,000 cells/mm3 (P = .035), and hypoalbuminemia (serum albumin level less than 3 mg/dL; P = .029).

Conclusion.

The Hines VA CDI severity score index appeared to display the strongest correlation for predicting more severe forms of CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 3 , March 2011 , pp. 220 - 228
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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