Predictors of Clostridium difficile infection-related mortality among older adults
Chopra T, Awali RA, Biedron C, Vallin E, Bheemreddy S, Saddler CM, Mullins K, Echaiz JF, Bernabela L, Severson R, Marchaim D, Lephart P, Johnson L, Thyagarajan R, Kaye KS, and Alangaden G. Predictors of Clostridium difficile infection-related mortality among older adults. Am J Infect Control 2016; 44(11):1219-1223.
Am J Infect Control
BACKGROUND: Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults.
METHODS: This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI.
RESULTS: One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI.
CONCLUSIONS: Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.
Medical Subject Headings
Aged; Aged, 80 and over; Case-Control Studies; Clostridium Infections; Clostridium difficile; Decision Support Techniques; Female; Humans; Male; Michigan; Middle Aged; Retrospective Studies; Survival Analysis; Tertiary Care Centers