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Factors Affecting Mortality and Length of Stay Following Clostridium Difficile Associated Diarrhoea: Validating A Consistent Scoring System

Wynell-Mayow W, Cash D, Muniz-Tererra G, Gkrania-Klotsas E, Khanduja V

Background Clostridium difficile associated diarrhoea (CDAD) is a severe threat, occurring with increasing frequency, severity and mortality. There is currently no consensus on a validated scoring system of CDAD severity, to guide the decisions of clinicians, and bodies such as Public Health England. Validation of these scoring systems could help improve patient outcomes and allow accurate resource allocation, particularly in light of novel, costly therapies.

Patients and methods This study is a prospective cohort analysis of 329 toxin assay positive CDAD episodes in a tertiary University hospital in the UK. Demographic parameters recorded included age, sex and comorbidities, whilst blood markers included haemoglobin, white cell count, creatinine and albumin. These along with other variables were compared with the 30-day all cause mortality and length of infection in this cohort of patients.

Results Sixty four percent of the patients were aged over 70, 61% were female, and CDAD was more common in patients with multiple co-morbidities. Our data showed that 96% of the cases were hospital acquired, of which 90% occurred on the medical wards. We found that older age, higher white blood cell count (WBC), higher creatinine and lower albumin were significant positive predictors of mortality, whilst haemoglobin, and Charlson co-morbidity index were non-predictive. We also found that amongst these parameters, old age and a higher white blood cell count were the only parameters associated with length of infection.

Conclusion Our data supports the results of a previous systematic review and contradicts many currently proposed risk stratification systems, including the guidance by Public Health England. We anticipate that our results will help direct the medical community to a consensus on a risk stratification system that uses albumin, creatinine, age and WBC as markers for CDAD mortality.