Risk Factors of Severe Clostridioides difficile Infection; Sequential Organ Failure Assessment Score, Antibiotics, and Ribotypes

Abstract

We aimed to determine whether the Sequential Organ Failure Assessment (SOFA) score predicts the prognosis of patients with Clostridioides difficile infection (CDI). In addition, the association between the type of antibiotic used and PCR ribotypes was analyzed. We conducted a propensity score (PS)-matched study and machine learning analysis using clinical data from all adult patients with confirmed CDI in three South Korean hospitals. A total of 5,337 adult patients with CDI were included in this study, and 828 (15.5%) were classified as having severe CDI. The top variables selected by the machine learning models were maximum body temperature, platelet count, eosinophil count, oxygen saturation, Glasgow Coma Scale, serum albumin, and respiratory rate. After propensity score-matching, the SOFA score, white blood cell (WBC) count, serum albumin level, and ventilator use were significantly associated with severe CDI (P < 0.001 for all). The log-rank test of SOFA score ≥ 4 significantly differentiated severe CDI patients from the non-severe group. The use of fluoroquinolone was more related to CDI patients with ribotype 018 strains than to ribotype 014/020 (P < 0.001). Even after controlling for other variables using propensity score matching analysis, we found that the SOFA score was a clinical predictor of severe CDI. We also demonstrated that the use of fluoroquinolones in hospital settings could be associated with the PCR ribotype in patients with CDI.

Keywords: CDI; Clostridioides difficile; antibiotics; machine learning; ribotyping; sequential organ failure assessment score.

FIGURE 1

Progression-free survival curves for three types of SOFA SCORES, including changes in SOFA score (A), quick SOFA (B), and SOFA (C).

FIGURE 2

Critical variables with SHAP values for predicting severe CDI. SHAP, Shapley additive explanation; CDI, Clostridioides difficile infection; SOFA, sequential organ failure assessment; CRP, C-reactive protein; GCS, Glasgow Coma Scale; BMI, body mass index. A SHAP value summary dot plot of the light gradient boosting model. The color of the SHAP dot represents the value of the feature, and the location of the dot on the X-axis represents the SHAP value. Red dots indicate higher values or affirmative responses, and blue dots indicate the opposite. A positive SHAP value indicates that the variables increase the likelihood of severe CDI.