BACKGROUND: Of the patients with a Clostridium difficile infection, 2% to 8% will progress to fulminant C. difficile colitis (fCDC), which carries high morbidity and mortality. No system exists to rapidly identify patients at risk for developing fCDC and possibly in need of surgical intervention. Our aim was to design a simple and accurate risk scoring system (RSS) for daily clinical practice. METHODS: We prospectively enrolled all patients diagnosed with a C. difficile infection and compared patients with and without fCDC. An expert panel, combined with data derived from previous studies, identified four risk factors, and a multivariable logistic regression model was performed to determine their effect in predicting fCDC. The RSS was created based on the predictive power of each factor, and calibration, discrimination, and test characteristics were subsequently determined. In addition, the RSS was compared with a previously proposed severity scoring system. RESULTS: A total of 746 patients diagnosed with C. difficile infection were enrolled between November 2010 and October 2012. Based on the log (odds ratio) of each risk factor, age greater than 70 years was assigned 2 points, white blood cell count equal to or greater than 20,000/μL or equal to or less than 2,000/μL was assigned 1 point, cardiorespiratory failure was assigned 7 points, and diffuse abdominal tenderness on physical examination was assigned 6 points. With the use of this system, the discriminatory value of the RSS (c statistic) was 0.98 (95% confidence interval, 0.96-1).The Hosmer-Lemeshow goodness-of-fit test showed a p value of 0.78, and the Brier score was 0.019. A value of 6 points was determined to be the threshold for reliably dividing low-risk ( <6) from high-risk (≥ 6) patients. CONCLUSION: The RSS is a valid and reliable tool to identify at the bedside patients who are at risk for developing fCDC. External validation is needed before widespread implementation. LEVEL OF EVIDENCE: Prognostic study, level II.
BACKGROUND: Of the patients with a Clostridium difficileinfection, 2% to 8% will progress to fulminant C. difficilecolitis (fCDC), which carries high morbidity and mortality. No system exists to rapidly identify patients at risk for developing fCDC and possibly in need of surgical intervention. Our aim was to design a simple and accurate risk scoring system (RSS) for daily clinical practice. METHODS: We prospectively enrolled all patients diagnosed with a C. difficileinfection and compared patients with and without fCDC. An expert panel, combined with data derived from previous studies, identified four risk factors, and a multivariable logistic regression model was performed to determine their effect in predicting fCDC. The RSS was created based on the predictive power of each factor, and calibration, discrimination, and test characteristics were subsequently determined. In addition, the RSS was compared with a previously proposed severity scoring system. RESULTS: A total of 746 patients diagnosed with C. difficileinfection were enrolled between November 2010 and October 2012. Based on the log (odds ratio) of each risk factor, age greater than 70 years was assigned 2 points, white blood cell count equal to or greater than 20,000/μL or equal to or less than 2,000/μL was assigned 1 point, cardiorespiratory failure was assigned 7 points, and diffuse abdominal tenderness on physical examination was assigned 6 points. With the use of this system, the discriminatory value of the RSS (c statistic) was 0.98 (95% confidence interval, 0.96-1).The Hosmer-Lemeshow goodness-of-fit test showed a p value of 0.78, and the Brier score was 0.019. A value of 6 points was determined to be the threshold for reliably dividing low-risk ( <6) from high-risk (≥ 6) patients. CONCLUSION: The RSS is a valid and reliable tool to identify at the bedside patients who are at risk for developing fCDC. External validation is needed before widespread implementation. LEVEL OF EVIDENCE: Prognostic study, level II.
Authors: Paula Ferrada; Rachael Callcut; Martin D Zielinski; Brandon Bruns; Daniel Dante Yeh; Tanya L Zakrison; Jonathan P Meizoso; Babak Sarani; Richard D Catalano; Peter Kim; Valerie Plant; Amelia Pasley; Linda A Dultz; Asad J Choudhry; Elliott R Haut Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Tyler McKechnie; Yung Lee; Jeremy E Springer; Aristithes G Doumouras; Dennis Hong; Cagla Eskicioglu Journal: Int J Colorectal Dis Date: 2019-11-21 Impact factor: 2.571
Authors: Andi L Shane; Rajal K Mody; John A Crump; Phillip I Tarr; Theodore S Steiner; Karen Kotloff; Joanne M Langley; Christine Wanke; Cirle Alcantara Warren; Allen C Cheng; Joseph Cantey; Larry K Pickering Journal: Clin Infect Dis Date: 2017-11-29 Impact factor: 9.079
Authors: Massimo Sartelli; Mark A Malangoni; Fikri M Abu-Zidan; Ewen A Griffiths; Stefano Di Bella; Lynne V McFarland; Ian Eltringham; Vishal G Shelat; George C Velmahos; Ciarán P Kelly; Sahil Khanna; Zaid M Abdelsattar; Layan Alrahmani; Luca Ansaloni; Goran Augustin; Miklosh Bala; Frédéric Barbut; Offir Ben-Ishay; Aneel Bhangu; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Laura A Canterbury; Fausto Catena; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria Elena Cocuz; Raul Coimbra; Charles H Cook; Yunfeng Cui; Jacek Czepiel; Koray Das; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina Magdalena Dumitru; Catherine Eckert; Christian Eckmann; Edward H Eiland; Mushira Abdulaziz Enani; Mario Faro; Paula Ferrada; Joseph Derek Forrester; Gustavo P Fraga; Jean Louis Frossard; Rita Galeiras; Wagih Ghnnam; Carlos Augusto Gomes; Venkata Gorrepati; Mohamed Hassan Ahmed; Torsten Herzog; Felicia Humphrey; Jae Il Kim; Arda Isik; Rao Ivatury; Yeong Yeh Lee; Paul Juang; Luis Furuya-Kanamori; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Wen Chien Ko; Francis D LaBarbera; Jae Gil Lee; Ari Leppaniemi; Varut Lohsiriwat; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick Alan Moore; Carl Erik Nord; Carlos A Ordoñez; Gerson Alves Pereira Júnior; Nicola Petrosillo; Francisco Portela; Basant K Puri; Arnab Ray; Mansoor Raza; Miran Rems; Boris E Sakakushev; Gabriele Sganga; Patrizia Spigaglia; David B Stewart; Pierre Tattevin; Jean Francois Timsit; Kathleen B To; Cristian Tranà; Waldemar Uhl; Libor Urbánek; Harry van Goor; Angela Vassallo; Jean Ralph Zahar; Emanuele Caproli; Pierluigi Viale Journal: World J Emerg Surg Date: 2015-08-20 Impact factor: 5.469
Authors: Joana Carmo; Susana Marques; Iolanda Chapim; Maria Ana Túlio; José Pedro Rodrigues; Miguel Bispo; Cristina Chagas Journal: GE Port J Gastroenterol Date: 2015-08-31