Table 3.
Univariate and multivariate predictors of development of complicated CDAD (N = 335 patients)
| Variablea,b | Patients with: |
Univariate analysis |
Multivariate analysis |
|||
|---|---|---|---|---|---|---|
| Uncomplicated CDAD | Complicated CDAD | OR (95% CI) | P | OR (95% CI) | P | |
| Age (yr)*c | 72 (57–81) | 77 (64–85) | 1.03 (1.007–1.05) | 0.010 | 1.028 (1.005–1.053) | 0.019 |
| Male sex | 141/288 (49) | 26/47 (55) | 1.29 (0.69–2.40) | 0.42 | ||
| Community-acquired CDAD | 46/288 (16) | 1/47 (2) | 0.11 (0.01–0.85) | 0.03 | ||
| Comorbidities | ||||||
| Charlson comorbidity Index score* | 2 (1–3) | 3 (2–6) | 1.28 (1.13–1.47) | <0.001 | 1.265 (1.105–1.449) | 0.001 |
| Malignancy | 83/288 (29) | 18/47 (38) | 1.53 (0.81–2.91) | 0.19 | ||
| Diabetes mellitus | 62/288 (21) | 15/47 (32) | 1.71 (0.87–3.35) | 0.12 | ||
| Chronic renal failure | 42/288 (18) | 15/47 (32) | 2.75 (1.37–5.50) | 0.004 | ||
| Chronic cardiac disease | 43/288 (15) | 9/47 (19) | 1.35 (0.61–2.99) | 0.46 | ||
| Chronic obstructive pulmonary disease | 41/288 (14) | 6/47 (13) | 0.88 (0.35–2.21) | 0.79 | ||
| Peripheral vascular disease | 34/288 (12) | 6/47 (13) | 1.09 (0.43–2.76) | 0.85 | ||
| Dementia | 31/288 (11) | 6/47 (13) | 1.21 (0.48–3.09) | 0.68 | ||
| Liver cirrhosis | 21/288 (7) | 6/47 (13) | 1.86 (0.71–4.88) | 0.21 | ||
| Transplant recipient | 23/288 (8) | 4/47 (8) | 1.07 (0.35–3.25) | 0.90 | ||
| Predisposing factors 1 mo preceding diagnosis | ||||||
| Prior antibiotic treatment | 240/288 (83) | 40/47 (85) | 1.14 (0.48–2.71) | 0.76 | ||
| Total length of AB treatment prior to CDAD diagnosis* | 12 (7–21) | 11 (7–20) | 1.004 (0.97–1.04) | 0.82 | ||
| Continued antibiotic use after CDAD diagnosis | 62/288 (21) | 17/47 (36) | 2.066 (1.07–3.99) | 0.02 | 2.009 (1.012–3.988) | 0.046 |
| Prior PPI use | 217/286 (76) | 38/47 (81) | 1.34 (0.62–2.91) | 0.45 | ||
| PPI use after CDAD diagnosis | 190/286 (66) | 34/47 (72) | 1.32 (0.66–2.62) | 0.42 | ||
| Prior treatment with loperamide | 27/288 (9) | 1/47 (2) | 0.21 (0.03–1.58) | 0.09 | ||
| Prior treatment with laxatives | 33/288 (11) | 4/47 (8) | 0.72 (0.24–2.13) | 0.55 | ||
| Enteral feeding | 21/288 (7) | 7/47 (15) | 2.225 (0.89–5.57) | 0.81 | ||
| Parenteral feeding | 18/288 (6) | 4/47 (8) | 1.39 (0.45–4.32) | 0.56 | ||
| Prior immunosuppressive agent use | 86/288 (30) | 15/47 (32) | 1.10 (0.57–2.14) | 0.78 | ||
| Clinical and biological markers at CDAD diagnosis | ||||||
| Abdominal pain | 117/288 (41) | 17/47 (36) | 0.83 (0.44–1.57) | 0.56 | ||
| Fever | 85/288 (29) | 12/47 (25) | 0.82 (0.40–1.65) | 0.57 | ||
| Blood leukocyte count (cells/ml)* | 10,600 (7,000–15,725) | 12,510 (7,820–18,025) | 1.00 (0.999–1.000) | 0.18 | ||
| Albumin value (g/dl)* | 2.82 (2.47–3.26) | 2.11 (1.60–2.75) | 0.22 (0.07–0.67) | 0.008 | ||
| Creatinine value (mg/dl)* | 0.93 (0.70–1.30) | 1.14 (0.93–1.85) | 1.18 (0.90–1.56) | 0.23 | ||
| CDAD treatment | ||||||
| No specific CDAD treatmentd | 276/288 (96) | 43/47 (91) | 0.47 (0.14–1.52) | 0.19 | ||
| First CDAD treatment with metronidazole | 249/288 (87) | 36/47 (77) | 0.49 (0.23–1.06) | 0.07 | ||
| First CDAD treatment with vancomycine | 26/288 (9) | 7/47 (15) | 1.84 (0.75–4.54) | 0.18 | ||
a
All quantitative variables (those indicated with an asterisk) are expressed as the median and interquartile range (IQR), while the remaining variables are reported as the absolute number and percentage.
b
CDAD, Clostridium difficile-associated disease; AB, antibiotic; PPI, proton pump inhibitor.
c
Pediatric patients (n = 13) were excluded from the analysis.
d
Two patients were included in a blinded clinical trial on C. difficile treatment, and we did not know which CDAD treatment they received.
e
If first CDAD treatment included both metronidazole and vancomycin, the patient was included in the vancomycin group.