Derivation and Validation of a Clostridium difficile Infection Recurrence Prediction Rule in a National Cohort of Veterans.
Derivation and Validation of a Clostridium difficile Infection Recurrence Prediction Rule in a National Cohort of Veterans.
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DOI：
10.1002/phar.2088
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发表时间：
2018-03
期刊：
影响因子：
4.1
通讯作者：
Frei CR
中科院分区：
文献类型：
--
作者：
Reveles KR;Mortensen EM;Koeller JM;Lawson KA;Pugh MJV;Rumbellow SA;Argamany JR;Frei CR
以前的研究已经确定了艰难梭菌感染(CDI)复发的危险因素，但很少有研究将这些因素整合到有助于临床决策的临床预测规则中。这项研究的目的是推导和验证CDI复发预测规则，以确定国家退伍军人队列中有首次复发风险的患者。回顾性队列研究。退伍军人事务部、信息学和计算基础设施。2002年10月1日至2014年9月30日期间，共有22,615名患有首发CDI的成年退伍军人健康管理局受益人；其中7,538名患者被分配到衍生队列，15,077名患者被分配到验证队列。使用后向Logistic回归在派生队列中建立了60天的CDI复发预测规则。那些在p<；0.01显著的变量被分配了与回归系数成比例的整数分数。然后在派生队列和单独的验证队列中对模型进行验证。然后将患者分为三个风险类别，并对每个类别的复发率进行描述。CDI复发预测规则包括以下预测变量及其各自的积分值：先前的第三代和第四代头孢菌素(1分)、先前的质子泵抑制剂(1分)、先前的止泻药(1分)、非严重的CDI(2分)和社区开始的CDI(3分)。在派生队列中，每个评分的60天CDI复发风险从7.5%(0分)到57.9%(8分)不等。风险评分与复发密切相关(R2=0.94)。将患者分为低危(0~2分)、中危(3~5分)和高危(6~8分)，复发率分别为8.9%、20.2%和35.0%。在验证队列中的发现是相似的。几个CDI和患者特有的因素与60天CDI复发风险独立相关。当纳入临床预测规则时，较高的风险评分和风险等级与CDI复发密切相关。提供者可以使用这一临床预测规则来识别CDI复发的高危患者，并帮助指导预防策略决策，同时考虑到临床判断。
Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision making. The objective of this study was to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. Retrospective cohort study. Veterans Affairs Informatics and Computing Infrastructure. A total of 22,615 adult Veterans Health Administration beneficiaries with first-episode CDI between October 1, 2002, and September 30, 2014; of these patients, 7,538 were assigned to the derivation cohort and 15,077 to the validation cohort. A 60-day CDI recurrence prediction rule was created in a derivation cohort using backward logistic regression. Those variables significant at p<0.01 were assigned an integer score proportional to the regression coefficient. The model was then validated in the derivation cohort and a separate validation cohort. Patients were then split into three risk categories, and rates of recurrence were described for each category. The CDI recurrence prediction rule included the following predictor variables with their respective point values: prior third-and fourth-generation cephalosporins (1 point), prior proton pump inhibitors (1 point), prior antidiarrheals (1 point), nonsevere CDI (2 points), and community-onset CDI (3 points). In the derivation cohort, the 60-day CDI recurrence risk for each score ranged from 7.5% (0 points) to 57.9% (8 points). The risk score was strongly correlated with recurrence (R2=0.94). Patients were split into low-risk (0-2 points), medium-risk (3-5 points), and high-risk (6-8 points) classes and had the following recurrence rates: 8.9%, 20.2%, and 35.0%, respectively. Findings were similar in the validation cohort. Several CDI and patient-specific factors were independently associated with 60-day CDI recurrence risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were strongly correlated with CDI recurrence. This clinical prediction rule can be used by providers to identify patients at high risk for CDI recurrence and help guide preventive strategy decisions, while accounting for clinical judgment.
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影响因子：
3.7
作者：
Martinez, Dalila;Heudebert, Gustavo;Estrada, Carlos
通讯作者：
Estrada, Carlos
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
29.4
作者：
Hu, Mary Y.;Katchar, Kianoosh;Kelly, Ciaran P.
通讯作者：
Kelly, Ciaran P.
DOI：
10.1093/cid/cis499
发表时间：
2012-08
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Crook DW;Walker AS;Kean Y;Weiss K;Cornely OA;Miller MA;Esposito R;Louie TJ;Stoesser NE;Young BC;Angus BJ;Gorbach SL;Peto TE;Study 003/004 Teams
通讯作者：
Study 003/004 Teams
影响因子：
7.6
作者：
Shivashankar, R.;Khanna, S.;Pardi, D. S.
通讯作者：
Pardi, D. S.