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Four Markers Predict Clostridium Difficile Mortality Risks

A research paper in BMC Infectious Diseases identifies a four-point test using easily measurable clinical variables to accurately identify patients at risk of dying from Clostridium difficile (C. diff) infection. The researchers determined the four points of the test by analyzing the clinical notes of 213 patients who had been transferred to the Royal Devon & Exeter NHS Foundation Trust (RD&E) specialized C. diff ward between 2007 and 2009. They then examined additional information gathered while the patients were in the hospital and in a follow-up at least 30-days after discharge.

The test involves four easily measurable clinical variables:
  1. Serum albumin levels (protein in blood plasma)
  2. Respiratory rate
  3. C-reactive protein (a protein found in blood, the levels of which rise in inflammation)
  4. White cell count

Threshold levels of serum albumin ≤ 24.5 g/L, C- reactive protein >228 mg/L, respiratory rate >17 resps/min and white cell count >12 × 103 mcL were associated with an increased risk of all-cause mortality.

The researchers acknowledge the clinical team can't definitely blame an increase or decrease in these markers on C. diff alone but note it can generally link an acute rise or decline in these variables around the time of infection diagnosis to C. diff.

And because the test uses only four variables, its simplicity would enable non-specialists to perform assessments within or around 48 hours of C. diff diagnosis--leading to the ability to assess more patients and establish interventions, the study noted.
Moreover, with accurate prediction, clinicians can appropriately manage at-risk patients and adjust the treatment plan after identifying a high-mortality risk, according to the research announcement.

"This really simple and quick tool, which any junior doctor could use in the middle of the night quickly and easily, flags up those who need a speedy and intensive treatment regime or more senior help," Ray Sheridan, consultant physician at the RD&E, said in the announcement. "The quicker we get on with the right treatment for the right patient the better their chances of recovery are."

Meanwhile, research in the May issue of the American Journal of Infection Control showed testing patients with three independent risk factors--recent hospitalization, chronic dialysis and corticosteroid use--when they're admitted could help hospitals identify asymptomatic C. diff. carriers.

To read the original study Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection 


To learn  more about the prevention of Clostridium Difficile Colitis take our online continuing education course,Clostridium Difficile Colitis Prevention And Management . You will earn 4.5 contact hours. To view course curriculum and objectives Click Here.
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