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. 2012 Aug;55 Suppl 2(Suppl 2):S149-53.
doi: 10.1093/cid/cis340.

Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis

Martijn P Bauer  1 , Marjolein P M Hensgens, Mark A Miller, Dale N Gerding, Mark H Wilcox, Adam P Dale, Warren N Fawley, Ed J Kuijper, Sherwood L Gorbach
Affiliations

Renal failure and leukocytosis are predictors of a complicated course of Clostridium difficile infection if measured on day of diagnosis

Martijn P Bauer et al. Clin Infect Dis. 2012 Aug.

Abstract

Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95% CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier analysis of time to resolution of diarrhea for patients with and without renal failure. The hazard ratio was 0.83 (95% confidence interval, .68–1.02).
See this image and copyright information in PMC

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