Prediction of recurrent clostridium difficile infection at the bedside: the GEIH-CDI score
Prediction of recurrent clostridium difficile infection at the bedside: the GEIH-CDI score
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DOI：
10.1016/j.ijantimicag.2017.09.010
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发表时间：
2018-03-01
影响因子：
10.8
通讯作者：
Fernandez-Felix, Borja M.
中科院分区：
文献类型：
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作者：
Cobo, Javier;Merino, Esperanza;Fernandez-Felix, Borja M.
艰难梭菌感染 (CDI) 的复发对患者和卫生系统都会产生重大影响。如果能够预测哪些患者的 CDI 复发风险增加，就可以选择新药物和疗法（包括粪便微生物移植）进行治疗，这些药物和疗法已被证明可以降低 CDI 复发的发生率。我们的目标是开发一种临床预测工具 GEIH-CDI 评分，以确定 CDI 复发的风险。在由 274 名诊断为 CDI 的患者组成的前瞻性队列中，使用逻辑回归研究了 CDI 复发的预测因子。该模型使用 Hosmer-Lemeshow 测试进行校准。该工具包含四个因素：年龄（70-79岁且≥80岁）、上一年CDI病史、粪便中毒素的直接检测以及治疗第五天持续腹泻。 GEIH-CDI 评分的功能在 183 名患者的前瞻性队列中得到了验证。 ROC 曲线下面积为 0.72 (0.65-0.79)。该工具的应用使得选择复发风险高（> 50%）的患者和复发风险低（< 10%）的患者成为可能。 GEIH-CDI 评分可能对治疗 CDI 患者的临床医生有用。 (C) 2017 年 Elsevier B.V. 和国际化疗协会。版权所有。
Recurrence of Clostridium difficile infection (CDI) has major consequences for both patients and the health system. The ability to predict which patients are at increased risk of recurrent CDI makes it possible to select candidates for treatment with new drugs and therapies (including fecal microbiota transplantation) that have proven to reduce the incidence of recurrence of CDI. Our objective was to develop a clinical prediction tool, the GEIH-CDI score, to determine the risk of recurrence of CDI. Predictors of recurrence of CDI were investigated using logistic regression in a prospective cohort of 274 patients diagnosed with CDI. The model was calibrated using the Hosmer-Lemeshow test. The tool comprises four factors: age (70-79 years and >= 80 years), history of CDI during the previous year, direct detection of toxin in stool, and persistence of diarrhea on the fifth day of treatment. The functioning of the GEIH-CDI score was validated in a prospective cohort of 183 patients. The area under the ROC curve was 0.72 (0.65-0.79). Application of the tool makes it possible to select patients at high risk (> 50%) of recurrence and patients at low risk (< 10%) of recurrence. GEIH-CDI score may be useful for clinicians treating patients with CDI. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.