Mortality and risk stratification in patients with Clostridium difficile-associated diarrhoea
Article first published online: 11 MAR 2009
© 2010 The Authors. Journal Compilation © 2010 The Association of Coloproctology of Great Britain and Ireland
Volume 12, Issue 3, pages 241–246, March 2010
How to Cite
Bhangu, S., Bhangu, A., Nightingale, P. and Michael, A. (2010), Mortality and risk stratification in patients with Clostridium difficile-associated diarrhoea. Colorectal Disease, 12: 241–246. doi: 10.1111/j.1463-1318.2009.01832.x
- Issue published online: 17 FEB 2010
- Article first published online: 11 MAR 2009
- Received 16 September 2008; accepted 16 October 2008
- Clostridium difficile;
- hospital acquired infection;
- scoring system
Aim This study aimed to describe the mortality in hospital patients with a first documented episode of Clostridium difficile-associated diarrhoea (CDAD) and to identify prognostic risk factors.
Method A cohort study of 158 patients was carried out with CDAD diagnosed over a 8-month period in a large acute UK teaching hospital. Logistic multivariable regression aided construction of a scoring system to stratify risk of death. The main outcome measure was the 30-day inpatient mortality.
Results Most affected patients were medical (n = 101, 64%), with general surgical (n = 30, 19%) and orthopaedic patients (n = 27, 17%) forming the rest. General surgical patients (mean age 78 years) were significantly younger than medical (82 years) or orthopaedic patients (85 years, P = 0.008). Overall 30-day mortality was 38%. 30-day mortality was higher in medical (46%) and orthopaedic patients (37%) compared with general surgical patients (13%, P = 0.006). Most surgical patients were those admitted as an emergency. A scoring system was devised and used within the first 72 h. A point was awarded for each of the following: age ≥ 80 years, clinically severe disease (sepsis, peritonitis, ≥ 10 episodes of diarrhoea in 24 h), WCC ≥ 20 or CRP ≥ 150, urea ≥ 15, albumin ≤ 20. Point counts of 0–1, 2–3 and 4–5 were associated with mortality rates of 22%, 55% and 89% respectively.
Conclusion Inpatient mortality from CDAD is high. Variability exists between different specialities. Patients at high risk of death can potentially be identified earlier using clinical and biochemical risk factors.