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Recurrent Clostridium difficile Infection Prediction Rule

Purpose: To evaluate a patient who has been treated for Clostridium difficile disease using the prediction rule of Hu et al.

Description

Hu et al developed a clinical prediction rule for identifying a patient at risk for recurrent Clostridium difficile disease following initial therapy. This can help to identify patients who may require closer monitoring and more aggressive management. The authors are from Beth Israel Deaconess Medical Center in Boston and Mater Misericordiae University Hospital in Dublin, Ireland.


Patient selection: history of Clostridium difficile diarrhea that has been treated

 

Recurrent Clostridium difficile disease may occur from 1 week to 2 months after a previous episode.

 

Parameters:

(1) age in years

(2) illness severity using the Patient Severity Index (PSI) of Horn et al (42.11.02)

(3) additional antibiotic therapy

(4) serum IgG level to toxin A (expressed in ELISA units)

 

Parameter

Finding

Points

age in years

<= 65 years of age

0

 

> 65 years of age

1

illness severity

mild to moderate

0

 

severe or fulminant

1

additional antibiotic therapy

no

0

 

yes

1

serum anti-Toxin A IgG

low levels (< 1.29 Elisa units)

2

 

high levels

0

 

where:

• The authors reported in a previous paper (Kyne et al). that a high IgM anti-toxin concentration on day 3 after the onset of the initial episode or a high IgG concentration  on day 12 were associated with a reduced risk of recurrence.

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• The higher the score the greater the risk of recurrent disease.

• A score >= 4 indicates a high risk for recurrence.

• Patients with a score of 0 had a very low rate of recurrence.

 

Performance:

• The performance was better in the derivation cohort than the validation cohort with AUC 94% in the former and 69% in the latter.

• Approximately 77% of patients are correctly classified. This is not surprising since patients with lower scores had risk of recurrent disease.


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Specialty

Objective

ICD-10