Validation of the SHEA/IDSA severity criteria to predict poor outcomes among inpatients and outpatients with Clostridioides difficile infection
Validation of the SHEA/IDSA severity criteria to predict poor outcomes among inpatients and outpatients with Clostridioides difficile infection
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DOI：
10.1017/ice.2020.8
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发表时间：
2020-05-01
影响因子：
4.5
通讯作者：
Rubin, Michael A.
中科院分区：
文献类型：
--
作者：
Stevens, Vanessa W.;Shoemaker, Holly E.;Rubin, Michael A.
目的：确定美国卫生保健流行病学学会（SHEA）和美国传染病学会（IDSA）艰难梭菌感染（CDI）严重性标准是否足以预测不良结局。设计：回顾性验证研究。设置和参与者：2006年1月1日至2016年12月31日退伍军人事务卫生系统中的CDI患者。方法：对于2010年标准，白细胞增多或血清肌酐（SCr）值>= 1.5倍基线的患者被归类为严重。对于2018年的标准，白细胞增多或SCr值>= 1.5 mg/dL的患者被归类为重度。不良结局定义为诊断后7天内住院或重症监护，14天内结肠切除术或30天全因死亡率;分别使用logistic回归将其建模为2010年和2018年标准的函数。在亚急性治疗中诊断的大部分发作中，严重程度无法分类（2010年，58.8%; 2018年，49.2%）。敏感性范围从使用2010年标准的亚急性护理的0.48到使用2018年标准的急性护理的0.73。两个版本的曲线下面积均较差且相似（亚急性护理为0.60，急性护理为0.57），但阴性预测值> 0.80。结论：模型在护理环境和标准版本中的性能普遍较差，但具有相当高的阴性预测值。亚急性护理环境中的许多患者（CDI病例的比例越来越大）无法分类。需要做更多的工作来制定标准，以确定有不良结局风险的患者。
Objective:To determine whether the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Clostridioides difficile infection (CDI) severity criteria adequately predicts poor outcomes.Design:Retrospective validation study.Setting and participants:Patients with CDI in the Veterans' Affairs Health System from January 1, 2006, to December 31, 2016.Methods:For the 2010 criteria, patients with leukocytosis or a serum creatinine (SCr) value >= 1.5 times the baseline were classified as severe. For the 2018 criteria, patients with leukocytosis or a SCr value >= 1.5 mg/dL were classified as severe. Poor outcomes were defined as hospital or intensive care admission within 7 days of diagnosis, colectomy within 14 days, or 30-day all-cause mortality; they were modeled as a function of the 2010 and 2018 criteria separately using logistic regression.Results:We analyzed data from 86,112 episodes of CDI. Severity was unclassifiable in a large proportion of episodes diagnosed in subacute care (2010, 58.8%; 2018, 49.2%). Sensitivity ranged from 0.48 for subacute care using 2010 criteria to 0.73 for acute care using 2018 criteria. Areas under the curve were poor and similar (0.60 for subacute care and 0.57 for acute care) for both versions, but negative predictive values were >0.80.Conclusions:Model performances across care settings and criteria versions were generally poor but had reasonably high negative predictive value. Many patients in the subacute-care setting, an increasing fraction of CDI cases, could not be classified. More work is needed to develop criteria to identify patients at risk of poor outcomes.