A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection
Background and Aims: Clostridioides difficile infection (CDI) is associated with a range of outcomes, and existing prediction models for death among patients with CDI are imprecise. Peripheral eosinopenia has been proposed as a novel risk factor for death among patients with CDI but has not been inc...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
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| Series: | Gastro Hep Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772572321000182 |
| _version_ | 1828373454482571264 |
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| author | Ying Wang Hojjat Salmasian Aaron Schluger Angela Gomez-Simmonds Alexa Choy Jianhua Li Jordan E. Axelrad Daniel E. Freedberg |
| author_facet | Ying Wang Hojjat Salmasian Aaron Schluger Angela Gomez-Simmonds Alexa Choy Jianhua Li Jordan E. Axelrad Daniel E. Freedberg |
| author_sort | Ying Wang |
| collection | DOAJ |
| description | Background and Aims: Clostridioides difficile infection (CDI) is associated with a range of outcomes, and existing prediction models for death among patients with CDI are imprecise. Peripheral eosinopenia has been proposed as a novel risk factor for death among patients with CDI but has not been incorporated into prediction models. This study aimed to develop and validate a prediction model for death among patients hospitalized with CDI that incorporated peripheral eosinopenia. Methods: Eosinopenia was defined as 0 eosinophils/μL on the soonest peripheral blood drawn within the 48-hour window of the CDI test (before or after). Adults were eligible for the study if they were hospitalized at any one of 3 large, unaffiliated hospital networks, tested positive for CDI by stool polymerase chain reaction, and received appropriate anti-CDI treatment. Patients were followed for all-cause death for up to 30 days. Results: There were 4518 unique hospitalized adults with CDI included (2142 in the derivation cohort and 2376 in the validation cohort). All-cause 30-day mortality was 9% and 10% in the cohorts. In the validation cohort, the factors most strongly associated with death were eosinopenia (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 1.77–3.50), albumin <3 g/dL (aOR 3.26, 95% CI 2.13–3.49), and creatinine >1.5 mg/dL (aOR 2.55, 95% CI 1.86–3.49). A 6-variable clinical prediction model was developed that improved on existing classification schemes for CDI severity (area under the receiver operating characteristic curve of 0.75 vs 0.68). Conclusion: Among adults hospitalized with CDI, peripheral eosinopenia was associated with increased risk of all-cause 30-day mortality. A prediction model incorporating peripheral eosinopenia was developed to improve care for hospitalized patients with CDI through risk stratification. |
| first_indexed | 2024-04-14T07:18:45Z |
| format | Article |
| id | doaj.art-89384aee60944712b0981ec7becfe1aa |
| institution | Directory Open Access Journal |
| issn | 2772-5723 |
| language | English |
| last_indexed | 2024-04-14T07:18:45Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj.art-89384aee60944712b0981ec7becfe1aa2022-12-22T02:06:13ZengElsevierGastro Hep Advances2772-57232022-01-01113844A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile InfectionYing Wang0Hojjat Salmasian1Aaron Schluger2Angela Gomez-Simmonds3Alexa Choy4Jianhua Li5Jordan E. Axelrad6Daniel E. Freedberg7Department of Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey; Correspondence: Address correspondence to: Ying Wang, MD, 300 Grand Street, Apt 421, Hoboken, New Jersey 07030.Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MassachusettsDepartment of Medicine, Westchester Medical Center, Valhalla, New YorkDepartment of Medicine, Columbia University Medical Center, New York, New YorkDepartment of Medicine, Columbia University Medical Center, New York, New YorkDepartment of Medicine, Columbia University Medical Center, New York, New YorkDepartment of Medicine, NYU Langone Health, New York, New YorkDepartment of Medicine, Columbia University Medical Center, New York, New YorkBackground and Aims: Clostridioides difficile infection (CDI) is associated with a range of outcomes, and existing prediction models for death among patients with CDI are imprecise. Peripheral eosinopenia has been proposed as a novel risk factor for death among patients with CDI but has not been incorporated into prediction models. This study aimed to develop and validate a prediction model for death among patients hospitalized with CDI that incorporated peripheral eosinopenia. Methods: Eosinopenia was defined as 0 eosinophils/μL on the soonest peripheral blood drawn within the 48-hour window of the CDI test (before or after). Adults were eligible for the study if they were hospitalized at any one of 3 large, unaffiliated hospital networks, tested positive for CDI by stool polymerase chain reaction, and received appropriate anti-CDI treatment. Patients were followed for all-cause death for up to 30 days. Results: There were 4518 unique hospitalized adults with CDI included (2142 in the derivation cohort and 2376 in the validation cohort). All-cause 30-day mortality was 9% and 10% in the cohorts. In the validation cohort, the factors most strongly associated with death were eosinopenia (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 1.77–3.50), albumin <3 g/dL (aOR 3.26, 95% CI 2.13–3.49), and creatinine >1.5 mg/dL (aOR 2.55, 95% CI 1.86–3.49). A 6-variable clinical prediction model was developed that improved on existing classification schemes for CDI severity (area under the receiver operating characteristic curve of 0.75 vs 0.68). Conclusion: Among adults hospitalized with CDI, peripheral eosinopenia was associated with increased risk of all-cause 30-day mortality. A prediction model incorporating peripheral eosinopenia was developed to improve care for hospitalized patients with CDI through risk stratification.http://www.sciencedirect.com/science/article/pii/S2772572321000182Peripheral EosinopeniaClostridioides difficile Infection (CDI)Prediction Model for Clostridioides difficile Infection Mortality |
| spellingShingle | Ying Wang Hojjat Salmasian Aaron Schluger Angela Gomez-Simmonds Alexa Choy Jianhua Li Jordan E. Axelrad Daniel E. Freedberg A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection Gastro Hep Advances Peripheral Eosinopenia Clostridioides difficile Infection (CDI) Prediction Model for Clostridioides difficile Infection Mortality |
| title | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
| title_full | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
| title_fullStr | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
| title_full_unstemmed | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
| title_short | A Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death After Hospitalization for Clostridioides difficile Infection |
| title_sort | prediction model incorporating peripheral eosinopenia as a novel risk factor for death after hospitalization for clostridioides difficile infection |
| topic | Peripheral Eosinopenia Clostridioides difficile Infection (CDI) Prediction Model for Clostridioides difficile Infection Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2772572321000182 |
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