TABLE 3.
Univariate analysis of risk factors predicting a poor outcomeh
| Factor | Value |
Univariate analysis result |
||
|---|---|---|---|---|
| Not poor outcome (n = 157) | Poor outcome (n = 70) | OR (95% CI) | P value | |
| Male gender (n [%]) | 81 (51.6) | 26 (37.1) | 1.8 (1.01–3.21) | 0.04 |
| Age (yr) (mean ± SD) | 62.8 ± 19.4 | 67.2 ± 18.8 | 2.76 (−9.7–1.16) | 0.12 |
| CCI (median [IQR]) | 4.0 (1.0–6.0) | 5.5 (4.0–7.0) | 0.005 | |
| Diabetes mellitus (n [%]) | 23 (14.6) | 12 (17.1) | 1.2 (0.56–2.58) | 0.63 |
| Active malignancya (n [%]) | 24 (15.3) | 16 (22.99 | 1.64 (0.81–3.33) | 0.17 |
| Hematological diseasea (n [%]) | 9 (5.7) | 4 85.7) | 0.99 (0.29–3.35) | 1.00 |
| Chemotherapya (n [%]) | 12 (7.6) | 15 (21.4) | 3.29 (1.45–7.48) | 0.003 |
| Hematopoietic stem cell transplantationa (n [%]) | 1 (0.6) | 2 (2.9) | 4.58 (0.41–51.4) | 0.22 |
| Solid organ transplantation (n [%]) | 19 (12.1) | 2 (2.9) | 0.21 (0.05–9.4) | 0.02 |
| Chronic renal failure (n [%]) | 29 (18.5) | 10 (14.3) | 0.73 (0.33–1.61) | 0.44 |
| Cirrhosis (n [%]) | 9 (5.7) | 6 (8.6) | 1.54 (0.52–4.51) | 0.43 |
| Concurrent corticosteroid therapy (any dose) (n [%]) | 32 (20.4) | 9 (12.9) | 0.57 (0.26–1.28) | 0.17 |
| Concurrent corticosteroid therapy (high doses)b (n [%]) | 7 (4.5) | 5 (7.1) | 1.65 (0.5–5.38) | 0.52 |
| Any immunosuppression (n [%]) | 45 (28.7) | 24 (34.3) | 1.30 (0.71–2.37) | 0.39 |
| Inflammatory bowel disease (n [%]) | 15 (9.6) | 1 (1.4) | 0.14 (0.02–1.06) | 0.02 |
| Cognitive impairment (n [%]) | 8 (5.1) | 5 (7.1) | 1.43 (0.45–4.54) | 0.54 |
| Admission to long-term care facility (n [%]) | 6 (3.8) | 7 (10.0) | 2.79 (0.90–8.65) | 0.12 |
| PPI therapyc (n [%]) | 94 (59.9) | 47 (67.1) | 1.37 (0.76–2.47) | 0.29 |
| H2 blocker therapyc (n [%]) | 7 (4.5) | 4 (5.7) | 1.30 (0.37–4.58) | 0.74 |
| Prior hospital admissiond (n [%]) | 85 (54.5) | 32 (45.7) | 0.70 (0.39–1.24) | 0.22 |
| No. of admissionsd (median [IQR]) | 1.0 (0.0–1.0) | 0.5 (0.0–1.0) | 0.43 | |
| Prior antibiotic therapy (n [%]) | ||||
| Within 4 weeks prior to diagnosis | 120 (76.4) | 56 (80.0) | 1.23 (0.62–2.46) | 0.55 |
| Within 12 weeks prior to diagnosis | 136 (86.6) | 64 (91.4) | 1.65 (0.63–4.28) | 0.30 |
| CDI symptoms as the main reason for consultatione (n [%]) | 68 (43.3) | 39 (55.7) | 1.64 (0.93–2.9) | 0.08 |
| Leukocytosisf (n [%]) | 13 (9.4) | 41 (60.3) | 14.72 (6.95–31.15) | 0.000 |
| White blood cell count [median (IQR)] | 8,300 (6,300–11,600) | 16,200 (8,575–21,925) | 0.000 | |
| Fever (n [%]) | 33 (21.0) | 50 (71.4) | 9.39 (4.93–17.91) | 0.000 |
| Acute renal failureg (n [%]) | 4 (2.7) | 30 (43.5) | 27.7 (9.2–83.3) | 0.000 |
| Maximum no. of daily bowel movements (median [IQR]) | 5.0 (3.0–7.0) | 6.0 (4.0–8.25) | 0.01 | |
| Concomitant antibiotic during CDI-specific treatment (n [%]) | 97 (61.8) | 61 (87.1) | 4.2 (1.94–9.05) | 0.000 |
| Recurrence in the following 8 weeks (n [%]) | 20 (12.7) | 16 (22.9) | 2.03 (0.98–4.21) | 0.05 |
| Positive for binary toxin (n [%]) | 24 (15.3) | 17 (24.3) | 1.78 (0.88–3.57) | 0.1 |
| Positive EIA result for A/B toxin (n [%]) | 63 (40.1) | 41 (58.6) | 2.11 (1.19–3.74) | 0.01 |
| Toxin B CT value (mean ± SD) | 26.05 ± 4.47 | 24.9 ± 4.24 | 0.63 (−0.09–2.4) | 0.07 |
| Delay from symptom onset to start of treatment (days) (median [IQR]) | 5.0 (2.0–9.75) | 3.0 (1.0–7.0) | 0.03 | |
| Type of therapy and delay from sample submission to lab | ||||
| No treatment (n [%]) | 33 (21.0) | 3 (4.3) | 5.94 (1.76–20.1) | 0.001 |
| Empirical treatment (n [%]) | 18 (11.5) | 16 (22.9) | 2.29 (1.1–4.81) | 0.026 |
| Advance treatment (days) (median ± SD) | 2.33 ± 1.84 | 2.25 ± 1.61 | 0.59 (−1.3–1.13) | 0.89 |
| Targeted treatment (n [%]) | 103 (65.6) | 51 (72.9) | 1.41 (0.75–2.61) | 0.28 |
| Delay (days) (median ± SD) | 2.23 ± 3.13 | 1.49 ± 2.24 | 0.49 (−0.22–1.71) | 0.13 |
| Unknown (n [%]) | 3 (1.9) | 0 (0.0) | 0.68 (0.63–0.75) | 0.55 |
| Treatment (n [%]) | ||||
| Oral metronidazole | 98 (62.8) | 26 (37.1) | 0.35 (0.19–0.62) | 0.000 |
| i.v. metronidazole | 21 (13.3) | 32 (45.7) | 5.4 (2.80–10.45) | 0.000 |
| Oral vancomycin | 34 (21.8) | 43 (61.4) | 5.7 (3.1–10.55) | 0.000 |
| Enemas of vancomycin | 0 (0.0) | 1 (1.4) | 0.31 (0.25–0.37) | 0.31 |
| Fidaxomicin | 0 (0.0) | 0 (0.0) | ||
| Rifaximin | 6 (3.8) | 1 (1.4) | 0.36 (0.04–3.1) | 0.44 |
| Probiotics | 12 (7.6) | 5 (7.1) | 0.93 (0.31–2.75) | 0.89 |
| Polyclonal gamma globulin | 0 (0.0) | 1 (1.4) | 0.30 (0.25–0.37) | 0.31 |
| i.v. tigecycline | 2 (1.3) | 7 (10.0) | 8.61 (1.74–42.6) | 0.004 |
| Surgical treatment | 0 (0.0) | 0 (0.0) | ||
a
Within the 6 months prior to the diagnosis of CDI.
b
Daily dose of >20 mg of prednisone or equivalent for more than 3 weeks at diagnosis.
c
Within the 4 weeks prior to the diagnosis of CDI.
d
Within the 12 weeks prior to the admission in which the diagnosis of CDI was made.
e
To the primary care physician, emergency department, or outpatient facility.
f
White blood cell count of ≥15,000 cells/ml.
g
Increase of serum creatinine of ≥1.5-fold compared to the premorbid level.
h
CCI, age-adjusted Charlson comorbidity index; CDI, Clostridium difficile infection; CI, confidence interval; CT, threshold cycle; EIA, enzyme immunoassay; IQR, interquartile range; OR, odds ratio; PPI, proton pump inhibitors; SD, standard deviation. Statistically significant results are shown in bold.