Risk factors for mortality in Clostridium difficile infection in the general hospital population: a systematic review - 19/08/12

Doi : 10.1016/j.jhin.2012.05.008

M.G. Bloomfield ^a,^b,^⁎ , J.C. Sherwin ^b, E. Gkrania-Klotsas ^c
^a Department of Clinical Microbiology, University College London Hospital NHS Foundation Trust, London, UK
^b Department of Public Health and Primary Care, Institute of Public Health, The University of Cambridge, Cambridge, UK
^c Department of Infectious Diseases, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Corresponding author. Address: Department of Clinical Microbiology, University College London Hospital NHS Foundation Trust, 65 Whitfield Street, London W1T 4EU, UK. Tel.: +44 7403 568687; fax: +44 2034 778992.

Summary

Background

Clostridium difficile infection (CDI) is one of the most important healthcare-associated infections, causing considerable mortality. Numerous severity scores have been proposed to identify patients with CDI at risk of mortality, but a systematic review of the evidence upon which these are based has never been published. Such a review could permit future development of scores that better predict mortality.

Aim

A systematic review of the published literature investigating clinically useful risk markers for mortality in CDI.

Methods

We searched MEDLINE 1950 to present, Web of Science with conference proceedings 1899 to present and BIOSIS Citation Index 1969 to present using PubMed and Web of Knowledge. Potential risk markers that had been evaluated by at least four studies were extracted.

Findings

Twenty-six studies, of 1617 initially identified, met inclusion criteria. The majority were retrospective cohort studies, mostly based in the USA. Older age, higher white blood cell count (WBC), higher creatinine level, lower albumin levels and, to a lesser extent, corticosteroid use were most frequently associated with mortality. Presence of fever, haemoglobin/haematocrit level, diarrhoea severity, presence of renal disease, diabetes, cancer, or nasogastric tube use did not appear to be associated with mortality.

Conclusion

Our results support the use of age, WBC, serum creatinine, serum albumin level and possibly pre-existing corticosteroid use as potentially useful risk markers for mortality in CDI. Our results do not support the use of fever, haemoglobin/haematocrit, diarrhoea severity and several comorbidities as useful risk markers, raising questions about their inclusion in CDI severity scores.

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Keywords : Clostridium difficile, Mortality, Pseudomembranous colitis, Severity