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. 2022 Jun;48(3):2013-2022.
doi: 10.1007/s00068-021-01769-y. Epub 2021 Sep 4.

Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system

Nasim Ahmed  1   2 , Yen-Hong Kuo  3 , Robyn K Guinto  4 , Jordan Purewal  4
Affiliations

Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system

Nasim Ahmed et al. Eur J Trauma Emerg Surg. 2022 Jun.

Abstract

Background: The purpose of the study is to identify the risk factors of mortality and develop a risk scoring system in patients who underwent colectomy due to Clostridium difficile colitis (CD-C).

Methods: Patient information was extracted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from 2012 to 2016. All adult patients who underwent colectomy for CD-C were included in the study. The data were split into training and testing data sets. A multiple logistic regression model was developed by backward deletion methods for risk assessment. To test the performance of the prediction model for 30-day mortality, a receiver operating characteristic (ROC) curve was generated and an area under the curve (AUC) was created.

Results: The training data set consisted of 434 (80%) patients, and the testing data set consisted of 91 (20%) patients. The overall mortality was 35%. No significant differences were found between the training and testing data sets for patient characteristics, comorbidities and mortality. The final model of the logistic regression model revealed a highly significant 30-day mortality for an age of ≥ 75 years old, ventilator dependency, Septic shock prior to surgery and a history of steroid use. The AUC value was 0.745 (95% CI 0.660-0.826). The risk of mortality scores range from 0 to 37. The highest score of 37 was related to an 83.9% predicted mortality.

Conclusion: Older age, septic shock, ventilator dependency requiring supportive care and a history of chronic steroid use were highly associated with mortality. A nomogram showing the scores and their relationship to mortality may provide guidance to point of care physicians for deciding the goal of care.

Level of evidence: Level of evidence: IV.

Keywords: Clostridium difficile colitis; Colectomy; Risk of mortality.

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References

    1. McDonald LC, Owings M, Jernigan JB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996 to 2003. Emerg Infect Dis. 2006;12:409–15. Accessed 9 sept 2020 - DOI
    1. https://www.cdc.gov/drugresistance/biggest-threats.html#cdiff
    1. Louie TJ, Miller MA, Mullane KM, OPT-80-003 Clinical Study Group, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422–31. https://doi.org/10.1056/NEJMoa0910812 (Medline: 21288078). - DOI - PubMed
    1. Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis. 2005;5:549–57. - DOI
    1. Cornely OA, Miller MA, Louie TJ, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55(Suppl 2):S154–61. - DOI

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