External validation of clinical prediction rules for complications and mortality following Clostridioides difficile infection

Autoři: Catherine Beauregard-Paultre aff001;  Claire Nour Abou Chakra aff001;  Allison McGeer aff002;  Annie-Claude Labbé aff003;  Andrew E. Simor aff004;  Wayne Gold aff005;  Matthew P. Muller aff006;  Jeff Powis aff007;  Kevin Katz aff008;  Suzanne M. Cadarette aff009;  Jacques Pépin aff001;  Louis Valiquette aff001
Působiště autorů: Department of Microbiology and Infectious Disease, Université de Sherbrooke, Sherbrooke, Québec, Canada aff001;  Mount Sinai Hospital, Toronto, Ontario, Canada aff002;  Division of Infectious Disease and Microbiology, CIUSSS de l’Est-de-l’Ile-de-Montréal, Montréal, Québec, Canada aff003;  Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada aff004;  Toronto General Hospital, Toronto, Ontario, Canada aff005;  St.Michael’s Hospital, Toronto, Ontario, Canada aff006;  Michael Garron Hospital, Toronto, Ontario, Canada aff007;  Department of Infection Control, North York General Hospital, Toronto, Ontario, Canada aff008;  Leslie Dan Faculty of Pharmacy and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada aff009;  Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada aff010
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226672



Several clinical prediction rules (CPRs) for complications and mortality of Clostridioides difficile infection (CDI) have been developed but only a few have gone through external validation, and none is widely recommended in clinical practice.


CPRs were identified through a systematic review. We included studies that predicted severe or complicated CDI (cCDI) and mortality, reported at least an internal validation step, and for which data were available with minimal modifications. Data from a multicenter prospective cohort of 1380 adults with confirmed CDI were used for external validation. In this cohort, cCDI occurred in 8% of the patients and 30-day all-cause mortality occurred in 12%. The performance of each tool was assessed using individual outcomes, with the same cut-offs and standard parameters.


Seven CPRs were assessed. Three predictive scores for cCDI showed low sensitivity (25–61%) and positive predictive value (PPV; 9–31%), but moderate specificity (54–90%) and negative predictive value (NPV; 82–95%). One model [using age, white blood cell count (WBC), narcotic use, antacids use, and creatinine ratio > 1.5× the normal level as covariates] showed a probability of 25% of cCDI at the optimal cut-off point with 36% sensitivity and 84% specificity. Two scores for mortality had low sensitivity (4–55%) and PPV (25–31%), and moderate specificity (71–78%) and NPV (87–92%). One predictive model for 30-day all-cause mortality [Charlson comorbidity index, WBC, blood urea nitrogen (BUN), diagnosis in ICU, and delirium] showed an AUC-ROC of 0.74. All other CPRs showed lower AUC values (0.63–0.69). Errors in calibration ranged from 12%- 27%.


Included CPRs showed moderate performance for clinical use in a large validation cohort with a majority of patients infected with ribotype 027 strains and a low rate of cCDI and mortality. These data show that better CPRs need to be developed and validated.

Klíčová slova:

Clostridium difficile – Creatinine – Death rates – Inpatients – Intensive care units – Systematic reviews – Colectomy


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