Prognostic Value Of Age And C-reactive Protein Combined With Charlson Comorbidity Index Score In Clostridium Difficile Infection Patients

Objective:Clostridium difficile(CD)is a common pathogen causing nosocomial infectious diarrhea.The increase in the morbidity and mortality of Clostridium difficile infection(CDI)has brought great economic burden to patients.At present,there is not an available indicator to predict the mortality of CDI patients.The purpose of this study was to analyzed the risk factors for mortality in CDI patients and explored the predictive efficacy of age and C-reactive protein(CRP)combined with Charlson co-morbidity index(CCI)score on death in CDI patients,to provide reference for the judgment of clinical prognosis in CDI patients.Methods:A retrospective analysis of 94 patients diagnosed with CDI in our hospital from November 2018 to November 2020.According to the prognosis,the patients were divided into death group(n=17)and survival group(n=77).Clinical and laboratory data were collected,complications were recorded,and the Charlson co-morbidity index(CCI)score was calculated.Chi-square test was used to compare count date.T test or Mann Whitney U test was used to measure data after normality test.Binary logistic regression analysis was used to determine the risk factors of death in CDI patients and establish a prediction model.The Receiver Operating Characteristic Curve(ROC)was used to evaluate its predictive value for death of CDI patients.Results:1 This study included 94 CDI patients,with an average age of(71.83±16.41)years old.There were 17 deaths with a mortality of 18.1%.There were 79 patients(84.0%)with CDI who had a history of antibiotic exposure in the last 30 days.CCI score of CDI patients ranged from 0 to 12,with a median score of 3(2 to 6),and 52 patients(55.3%)with CCI scores≥3.Among the diseases included in the CCI score,the most common comorbidity were hemiplegia in 29 cases(30.9%)and chronic obstructive pulmonary disease in 26 cases(27.7%).CDI patients was associated with infections other than intestinal infection in 59 cases(62.8%),among which the most common infection was pulmonary infection in 51 cases(54.3%).2 The age,CCI score,WBC,ALB,PCT,CRP,AST,pulmonary infection and deep vein operation were statistically different in the CDI death group compared with the survival group(P<0.05).Among all co-morbidity,congestive heart failure,peripheral vascular disease,Solid tumor(localized),and metastatic tumors were statistically significant differences(P<0.05).Logistic multivariate regression analysis showed that age(OR=1.071,95%CI: 1.008-1.139,P= 0.028)CRP(OR=1.012,95%CI: 1.003-1.021,P=0.007)and CCI score(OR=1.546,95%CI: 1.169-2.046,P=0.002)were independent risk factors for death in CDI patients.3 The calculation formula of age-CRP-CCI in the combined model was0.069× age +0.012×CRP+0.436×CCI-10.358,and the optimal critical value of the combined model was 0.193.ROC curves were made by age,CRP,CCI score and age-CRP-CCI combined model,and the AUC of the four groups were 0.739,0.765,0.825,0.928,respectively.Compared with the single factor,the AUC of age-CRP-CCI combined model was larger and the predictive value was higher,with statistical differences(P<0.05).The ageCRP-CCI combined model has predictive value for the prognosis of CDI patients.Conclusion:1 CDI patients were mostly older,with more co-morbidity diseases and a history of antibiotic exposure.In this study,the all-cause mortality rate of CDI patients was 18.1%,which was relatively high.2 Age,CRP and CCI score were independent risk factors for mortality in CDI patients.The higher age,CRP,and CCI scores,the higher risk of death in CDI patients.3 The age-CRP-CCI combined model has predictive value for the mortality of CDI patients.The age-CRP-CCI combined model > 0.193 had a strong predictive effect on the mortality of CDI patients.