Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection
Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection
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DOI：
10.14423/smj.0000000000000687
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发表时间：
2017-08-01
影响因子：
1.1
通讯作者：
Tinsley, Andrew
中科院分区：
文献类型：
--
作者：
Chintanaboina, Jayakrishna;Navabi, Seyedehsan;Tinsley, Andrew
艰难梭菌感染（CDI）是美国发病率和死亡率的重要原因，也是最常见的医院感染，相关的年成本约为30亿美元。随着CDI发生和复发的新危险因素的发现，CDI的流行病学发生了变化。本研究的目的是确定CDI住院患者30天死亡率的预测因素。方法：选取2011年1月至2014年12月在我校附属医院诊断为CDI的所有患者。数据提取采用电子病历和图表审查。将发生CDI后30天内死亡的所有患者的数据与发生CDI后30天存活的患者的数据进行比较。通过使用逻辑回归进行双变量比较，找到重要的预测变量子集后，为死亡率创建了多变量逻辑回归模型。结果：在研究期间，共有893例患者被诊断为CDI。平均年龄62岁，49.5%为女性。平均住院时间11.73天。在893例CDI患者中，98例（10.97%）在CDI发生后30天内死亡。CDI复发76例（8.51%）。在多变量logistic回归分析中，发现消化性溃疡疾病、高龄、Charlson合并症指数和重症监护病房状态与30天死亡率显著相关。酸抑制与CDI死亡率之间无显著相关性。结论：高龄、Charlson合并症指数、重症监护病房状态和消化性溃疡疾病是CDI住院患者全因30天死亡率的预测因素。
Objectives: Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of approximately $3 billion. The epidemiology of CDI has changed with the identification of novel risk factors for incident and recurrent CDI. The aim of this study was to identify the predictors of 30-day mortality in hospitalized patients with CDI.Methods: We identified all of the patients diagnosed as having CDI from January 2011 to December 2014 at our university-setting hospital. Data were extracted using electronic medical records and chart review. The data of all of the patients who died within 30 days of incident CDI were compared with those who survived beyond 30 days of incident CDI. A multivariable logistic regression model was created for mortality after finding a subset of significant predictor variables by making bivariate comparisons also using logistic regression.Results: A total of 893 patients were diagnosed as having CDI during the study period. The mean age was 62 years and 49.5% were women. The mean length of hospital stay was 11.73 days. Of the 893 patients with CDI, 98 (10.97%) died within 30 days of incident CDI. CDI recurrence was noted in 76 patients (8.51%). On multivariate logistic regression analysis, peptic ulcer disease, advanced age, Charlson comorbidity index, and intensive care unit status were found to be significantly associated with 30-day mortality. There was no significant association between acid suppression and CDI mortality.Conclusions: Advanced age, Charlson comorbidity index, intensive care unit status, and peptic ulcer disease are predictors of all-cause 30-day mortality in hospitalized patients with CDI.