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Retrospective, propensity score--matched study examining the relationship between frailty and Clostridioides difficile infection in a national cohort of US veterans - 13/11/24

Doi : 10.1016/j.ajic.2024.08.020 
Kelly R. Reveles, PharmD, PhD a, b, c, , Kelsey A. Strey, PharmD a, b, Esther L. Albuquerque a, b, Damaris Jacota a, b, Xavier Jones, BS a, c, Joseph J. Carreno, PharmD, MPH d
a College of Pharmacy, The University of Texas at Austin, Austin, TX 
b School of Medicine, University of Texas Health San Antonio, San Antonio, TX 
c Research Department, South Texas Veterans Health Care System, San Antonio, TX 
d Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY 

Address correspondence to Kelly R. Reveles, PharmD, PhD, Pharmacotherapy Education and Research Center, UT Health San Antonio, 7703 Floyd Curl Drive, MC 6200, San Antonio, TX.Pharmacotherapy Education and Research Center, UT Health San Antonio7703 Floyd Curl Drive, MC 6200San AntonioTX

Resumen

Background

Frailty is often more predictive of disease and mortality compared with chronological age. This study determined the impact of frailty on Clostridioides difficile infection (CDI) risk and outcomes in a national veteran population.

Methods

This was a retrospective cohort study of CDI and control veteran inpatients and outpatients from fiscal year 2003 to 2018. Baseline frailty was presented as the Veterans Affairs (VA) Frailty Index. Propensity score--matched analyses were conducted to compare CDI risk, CDI health outcomes, and 1-year new-onset frailty-associated conditions.

Results

A total of 11,451 CDI and 11,451 matched control patients were included. Baseline frailty conditions were more common among CDI patients, especially involuntary weight loss (6.0% vs 3.4%, P < .001) and anemia (24.6% vs 18.7%, P < .001). VA Frailty Index was significantly higher for CDI patients (0.13 vs 0.11, P = .019). Frail CDI patients were more likely to experience 30-day mortality (11.3% vs 1.1%, P < .001) and 60-day CDI recurrence (20.4% vs 16.3%, P < .001) compared with non-/prefrail CDI patients. At 1year, CDI patients were significantly more likely to be categorized as frail (19.6% vs 17.0%, P < .001).

Conclusions

This study demonstrated the potential association between frailty and CDI risk and health outcomes, as well as new-onset frailty diagnoses in patients who develop CDI.

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Highlights

Clostridioides difficile infection (CDI) and frailty was studied in US veterans.
Frailty conditions were more common among CDI patients compared with non-CDI patients.
Frail CDI patients were more likely to experience mortality and CDI recurrence.
At 1year, CDI patients were more likely to be frail compared with non-CDI patients.

El texto completo de este artículo está disponible en PDF.

Key Words : Mortality, Epidemiology


Esquema


 Conflicts of interest: None to report.
 Funding/support: Institutional funding from The University of Texas at Austin was used to support this work. Additionally, KRR is supported by the National Institutes of Health (UM1TR004538, P30AG044271).


© 2024  The Authors. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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