Prospective Derivation and Validation of a Clinical Prediction Rule for Recurrent Clostridium difficile Infection
Prospective Derivation and Validation of a Clinical Prediction Rule for Recurrent Clostridium difficile Infection
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DOI：
10.1053/j.gastro.2008.12.038
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发表时间：
2009-04-01
期刊：
影响因子：
29.4
通讯作者：
Kelly, Ciaran P.
中科院分区：
文献类型：
--
作者：
Hu, Mary Y.;Katchar, Kianoosh;Kelly, Ciaran P.
背景和目的：预防艰难梭菌感染（CDI）复发是一个重大的治疗挑战。先前对63例CDI患者进行的前瞻性研究确定了与复发相关的风险因素。本研究旨在使用上述推导队列开发复发性CDI的预测规则，并在独立验证队列中前瞻性评估该规则的性能。研究方法：临床预测规则通过多变量logistic回归分析开发，包括以下变量：年龄>65岁，严重或暴发性疾病（通过Horn指数），CDI治疗后额外使用抗生素。第二条规则将抗毒素A的免疫球蛋白G（IgG）血清浓度数据与临床预测因素相结合。然后在89例CDI患者的独立队列中前瞻性评估这两种规则。结果如下：临床预测规则区分了复发性CDI和非复发性CDI患者，推导队列中的受试者工作特征曲线下面积为0.83（95%置信区间[CI]：0.70-0.95），验证队列中为0.80（95% CI：0.67-0.92）。该规则分别正确分类了推导和验证队列中77.3%（95% CI：62.2%-88.5%）和71.9%（95% CI：59.2%-82.4%）的患者。组合规则在推导队列中表现良好，但在验证队列中表现不佳（受试者工作特征曲线下面积分别为0.89和0.62;诊断准确率分别为93.8%和69.2%）。结论：我们前瞻性地推导并验证了复发性CDI的临床预测规则，该规则简单、可靠、准确，可用于识别最有可能从预防复发措施中获益的高危患者。
Background & Aims: Prevention of recurrent Clostridium difficile infection (CDI) is a substantial therapeutic challenge. A previous prospective study of 63 patients with CDI identified risk factors associated with recurrence. This study aimed to develop a prediction rule for recurrent CDI using the above derivation cohort and prospectively evaluate the performance of this rule in an independent validation cohort. Methods: The clinical prediction rule was developed by multivariate logistic regression analysis and included the following variables: age >65 years, severe or fulminant illness (by the Horn index), and additional antibiotic use after CDI therapy. A second rule combined data on serum concentrations of immunoglobulin G (IgG) against toxin A with the clinical predictors. Both rules were then evaluated prospectively in an independent cohort of 89 patients with CDI. Results: The clinical prediction rule discriminated between patients with and without recurrent CDI, with an area under the curve of the receiver-operating-characteristic curve of 0.83 (95% confidence interval [CI]: 0.70-0.95) in the derivation cohort and 0.80 (95% Cl: 0.67-0.92) in the validation cohort. The rule correctly classified 77.3% (95% CI: 62.2%-88.5%) and 71.9% (95% CI: 59.2%-82.4%) of patients in the derivation and validation cohorts, respectively. The combined rule performed well in the derivation cohort but not in the validation cohort (area under the curve of the receiver-operating-characteristic curve, 0.89 vs 0.62; diagnostic accuracy, 93.8% vs 69.2%, respectively). Conclusions: We prospectively derived and validated a clinical prediction rule for recurrent CDI that is si le, reliable, and accurate and can be used to identify high-risk patients most likely to benefit from measures to prevent recurrence.