Comparison of Clinical Severity Score Indices for Clostridium difficile Infection
Comparison of Clinical Severity Score Indices for Clostridium difficile Infection
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DOI：
10.1086/658336
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发表时间：
2011-03-01
影响因子：
4.5
通讯作者：
Murthy, A. Rekha
中科院分区：
文献类型：
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作者：
Fujitani, Shigeki;George, W. Lance;Murthy, A. Rekha
客观的。比较艰难梭菌感染 (CDI) 的 8 个严重程度评分指数。设计。前瞻性观察研究。方法。这项研究于2006年7月至10月进行。对3所大学附属医院所有粪便艰难梭菌毒素检测结果呈阳性的住院患者进行了评估。如果患者在住院期间出现至少一种以下临床事件，则被认为是严重感染：(1) 诊断后 30 天内因 CDI 死亡，(2) CDI 需要进行结肠切除术，或 (3) 入住重症监护病房以治疗 CDI 并发症。以已发布的严重 CDI 标准为基准，根据 8 个严重程度评分指数评估严重程度。研究的 8 个严重程度评分指数是 Beth Israel、匹兹堡大学医学中心第 1 版、匹兹堡大学医学中心第 2 版、海因斯弗吉尼亚州、修改后的伊利诺伊大学、卡尔加里大学第 1 版、卡尔加里大学第 2 版和天普大学。 结果。根据定义的严重 CDI 标准进行评估，在接受评估的 184 名 CDI 患者中，19 名重症病例，165 名非重症病例。研究的 8 个严重程度评分指数的敏感性范围为 63.2% 至 84.2%，特异性范围为 59.4% 至 93.9%。 Hines VA 指数的 kappa 得分最高（0.69 [95% 置信区间，0.54-0.83]），其次是匹兹堡大学医学中心第 1 版指数。多变量分析确定的严重 CDI 的独立危险因素为腹胀 (P=.007)、发热（体温 38.0 摄氏度或以上；P=.042）、白细胞计数至少 20,000 个细胞/mm(3) (P=.035) 和低白蛋白血症（血清白蛋白水平低于 3 mg/dL；P=.029）。结论。 Hines VA CDI 严重程度评分指数似乎显示出预测更严重 CDI 形式的最强相关性。
OBJECTIVE. To compare 8 severity score indices for Clostridium difficile infection (CDI).DESIGN. Prospective observational study.METHODS. This study was conducted from July through October 2006. All hospitalized patients in 3 university-affiliated hospitals with a positive fecal Clostridium difficile toxin assay result were evaluated. Infection was considered severe if patients had at least 1 of the following clinical events during their hospitalization: (1) death attributed to CDI within 30 days after diagnosis, (2) colectomy necessitated by CDI, or (3) intensive care unit admission for management of complications attributed to CDI. Severity was assessed on the basis of 8 severity score indices, using published criteria for severe CDI as the benchmark. The 8 severity score indices studied were Beth Israel, University of Pittsburgh Medical Center version 1, University of Pittsburgh Medical Center version 2, Hines VA, modified University of Illinois, University of Calgary version 1, University of Calgary version 2, and University of Temple.RESULTS. Of 184 patients with CDI evaluated, 19 had severe cases and 165 had nonsevere cases, as assessed on the basis of the defined severe CDI criteria. Sensitivities of the 8 severity score indices studied ranged from 63.2% to 84.2%, and specificities ranged from 59.4% to 93.9%. The Hines VA index had the highest kappa score (0.69 [95% confidence interval, 0.54-0.83]), followed by the University of Pittsburgh Medical Center version 1 index. Independent risk factors for severe CDI determined by multivariate analysis were abdominal distention (P=.007), fever (temperature, 38.0 degrees C or above; P=.042), white blood cell count of at least 20,000 cells/mm(3) (P=.035), and hypoalbuminemia (serum albumin level less than 3 mg/dL; P=.029).CONCLUSION. The Hines VA CDI severity score index appeared to display the strongest correlation for predicting more severe forms of CDI.