Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients.
Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients.
复制标题
住院肿瘤患者艰难梭菌腹泻预测模型的确定和验证。
作者：
K. Hornbuckle;A. Chak;H. Lazarus;G. Cooper;L. Kutteh;R. Gucalp;P. Carlisle;J. Sparano;P. Parker;R. Salata
背景
在接受化疗的癌症患者中，艰难梭状芽孢杆菌结肠炎是发病率的常见原因，这可能会延长住院时间。识别感染的技术往往会推迟治疗的开始。
患者和方法
在这项回顾性病例对照分析中，我们在1988年至1993年因血液系统恶性肿瘤/骨髓移植病房(A医院)住院的29名患者中确定了艰难梭菌相关性腹泻的预测因素。然后，我们用58例艰难梭菌病例和74例对照验证了我们的模型，这些病例来自另一家机构(B医院)的肿瘤科。
结果
多因素分析发现，低强度化疗(P<；0.001)、未使用万古霉素(P=0.03)和过去两个月内住院(P=0.05)是艰难梭菌结肠炎的独立预测因素。使用接受者操作员特征评分对这些变量的预测能力进行加权；低强度化疗被分配2分，没有静脉注射万古霉素的患者被分配1分，既往住院的患者被分配1分(P<；0.001，趋势为X2)。A医院患者的受试者工作特征(ROC)曲线面积为0.78，B医院患者ROC曲线面积为0.70，表明辨别能力中度下降。与A医院患者相比，1989年至1994年B医院住院患者中女性比例较高(P=0.04)，全身万古霉素用量较少(P=0.01)，中性粒细胞减少(P<；0.05)，化疗方案强度较小(P<；0.05)。尽管这些机构的患者在人口统计学上存在这些差异，但我们的预测模型在B医院的患者中得到了验证(趋势的P=0.02，x~2)。
结论
这项研究的结果可能有助于临床医生预测住院的免疫功能低下的肿瘤科患者患艰难梭菌病的风险，并可能有助于指导经验性治疗，同时等待粪便毒素检测的结果。
BACKGROUND
Clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. Techniques for identifying infection often delay the initiation of therapy.
PATIENTS AND METHODS
In this retrospective case-control analysis, we identified predictors for C. difficile-associated diarrhea in 29 patients hospitalized from 1988 to 1993 on a hematologic malignancy/bone marrow transplant unit (hospital A). We then validated our model with 58 C. difficile cases and 74 controls admitted to an oncology unit from a different institution (hospital B).
RESULTS
We found that low intensity of chemotherapy (P < 0.001), lack of parenteral vancomycin use (P = 0.03) and hospitalization within the past two months (P = 0.05) were independently predictive of C. difficile colitis by multivariate analysis. These variables were weighted for predictive capability using a receiver operator characteristic score; low intensity chemotherapy was assigned two points, lack of parenteral vancomycin received one point and prior hospitalization one point (P < 0.001 by chi 2 for trend). The receiver operating characteristic (ROC) curve areas were 0.78 for patients at hospital A and 0.70 at hospital B indicating moderate drop off in discrimination. Compared to hospital A patients, hospital B patients hospitalized between 1989 and 1994 were more often women (P = 0.04), received less systemic vancomycin (P = 0.01), were less frequently neutropenic (P < 0.05), and received less intense chemotherapy regimens (P < 0.05). Despite these differences in demographics in patients between these institutions, our predictive model was validated in hospital B patients (P = 0.02 by chi 2 for trend).
CONCLUSIONS
The results of this study may help clinicians predict the risk of C. difficile disease in the hospitalized immunocompromised oncology patient and may help guide empiric therapy while awaiting results of stool toxin assays.
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影响因子：
158.5
作者：
MAYER, RJ;DAVIS, RB;FREI, E
通讯作者：
FREI, E
由于地毯污染而引起的曲霉病。
影响因子：
4.5
作者：
Gerson,SL;Parker,P;Jacobs,MR;Creger,R;Lazarus,HM
通讯作者：
Lazarus,HM
影响因子：
--
作者：
Cudmore,MA;SilvaJr,J;Fekety,R;Liepman,MK;Kim,KH
通讯作者：
Kim,KH
预测住院腹泻患者的艰难梭菌粪便细胞毒素结果。
影响因子：
5.7
作者：
Katz,DA;Bates,DW;Rittenberg,E;Onderdonk,A;Sands,K;Barefoot,LA;Snydman,D
通讯作者：
Snydman,D