High delayed mortality after the first episode of Clostridium difficile infection

• Published in: Anaerobe Vol. 57; pp. 93 - 98
• Main Authors: Cózar, Alberto, Ramos-Martínez, Antonio, Merino, Esperanza, Martínez -García, Cristina, Shaw, Evelyn, Marrodán, Teresa, Calbo, Esther, Bereciartúa, Elena, Sánchez- Muñoz, Luis A., Salavert, Miguel, Pérez-Rodríguez, M. Teresa, García, Dácil, Bravo-Ferrer, J. María, Gálvez-Acebal, Juan, Henríquez, César, Cuquet, Jordi, Gil-Campesino, Helena, Torres, Luis, Sánchez-Porto, Antonio, Royuela, Ana, Cobo, Javier, Romero, José, Muriel, Alfonso, Giner, Livia, Federico, Ferrere, Rocío, Martínez-Ruiz S., Martos, Purificación, Sardiña, Cristina, Elena, Aguirre, Badía, Cristina, Perales, Alfonso, De Santos-Castro, Pedro A., Miguel, AngelBratos-Pérez, Cuellar, Sandra, Eva, Gonzalez, llinares, Pedro, Laura, Castelo, Morales, Isabel, Delgado-Iribarren, Alberto, Mairal, Pilar
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2019
• Subjects: Aged; Clostridium difficile; Comorbidity; Fecal incontinence; Immunosuppression; Mortality; Fecal incontinence; Immunosuppression; Aged; Comorbidity; Mortality; Clostridium difficile
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2019.04.004

Clostridium difficile infection (CDI) is characterized by a high delayed and unrelated mortality. Predicting delayed mortality in CDI patients could allow the implementation of interventions that could reduce these events. A prospective multicentric study was carried out to investigate prognostic factors associated with mortality. It was based on a cohort (July 2015 to February 2016) of 295 patients presenting with CDI. Logistic regression was used and the model was calibrated using the Hosmer-Lemeshow test. The mortality rate at 75 days in our series was 18%. Age (>65 years), comorbidity (defined by heart failure, diabetes mellitus with any organ lesion, renal failure, active neoplasia or immunosuppression) and fecal incontinence at clinical presentation were associated with delayed (75-day) mortality. When present, each of the aforementioned variables added one point to the score. Mortalities with 0, 1, 2 and 3 points were 0%, 9.4%, 18.5% and 38.2%, respectively. The area under the ROC curve was 0.743, and the Hosmer-Lemeshow goodness-of-fit test p value was 0.875. Therefore, the prediction of high delayed mortality in CDI patients by our scoring system could promote measures for increasing survival in suitable cases. •CDI patients present a high, non-infection related, delayed mortality.•Age, comorbidity and fecal incontinence at diagnosis are related to patient outcome.•A scoring system based on these variables may predict mortality.•Preventive measures could eventually be implemented to improve patient prognoses.