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Clostridium difficile Infection (CDI) Severity Index (CSI)

Purpose: To identify a patient with severe Clostridium difficile disease at the time of hospital admission using the CSI of Lungulescu et al.

Description

Lungulescu et al reported an index for identifying a patient with severe Clostridium difficile infection (CDI) at the time of hospital admission. This can help to identify a patient who may require more aggressive management. The authors are from Dunbury Hospital in Dunbury, Connecticut.


Patient selection: Clostridium difficile disease

 

Parameters on hospital admission:

(1) history of malignancy

(2) white blood cell count

(3) serum albumin

(4) ratio of serum creatinine on admission to the patient’s baseline value

 

ratio of serum creatinine to baseline value =

= (serum creatinine on hospital admission) / (serum creatinine at baseline)

 

Parameter

Finding

Points

history of malignancy

no

0

 

yes

1

white blood cell count

<= 20,000 per µL

0

 

> 20,000 per µL

1

serum albumin

>= 3.0 g/dL

0

 

< 3.0 g/dL

1

serum creatinine ratio

<= 1.5

0

 

> 1.5

1

 

where:

• According to Table 1 the cutoff for WBC should be >= 20,000 per µL.

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 4

• A cutoff >= 2 identifies a patient who is at risk for severe Clostridium difficile disease.

 

Performance:

• The sensitivity of the cutoff was 82% and specificity 65%.

• A score >= 3 had a specificity of 92% but sensitivity of 29%.

 

Limitations:

• The patient’s baseline value for serum creatinine needs to be known.


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Specialty

Objective

ICD-10