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Validation of the SHEA/IDSA severity criteria to predict poor outcomes among inpatients and outpatients with Clostridioides difficile infection

Published online by Cambridge University Press:  30 January 2020

Vanessa W. Stevens
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Holly E. Shoemaker
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
Makoto M. Jones
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Barbara E. Jones
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Pulmonary Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Richard E. Nelson
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Karim Khader
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Matthew H. Samore
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
IDEAS Center of Innovation, Veterans’ Affairs Salt Lake City Health Care System, Salt Lake City, Utah Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Corresponding

Abstract

Objective:

To determine whether the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Clostridioides difficile infection (CDI) severity criteria adequately predicts poor outcomes.

Design:

Retrospective validation study.

Setting and participants:

Patients with CDI in the Veterans’ Affairs Health System from January 1, 2006, to December 31, 2016.

Methods:

For the 2010 criteria, patients with leukocytosis or a serum creatinine (SCr) value ≥1.5 times the baseline were classified as severe. For the 2018 criteria, patients with leukocytosis or a SCr value ≥1.5 mg/dL were classified as severe. Poor outcomes were defined as hospital or intensive care admission within 7 days of diagnosis, colectomy within 14 days, or 30-day all-cause mortality; they were modeled as a function of the 2010 and 2018 criteria separately using logistic regression.

Results:

We analyzed data from 86,112 episodes of CDI. Severity was unclassifiable in a large proportion of episodes diagnosed in subacute care (2010, 58.8%; 2018, 49.2%). Sensitivity ranged from 0.48 for subacute care using 2010 criteria to 0.73 for acute care using 2018 criteria. Areas under the curve were poor and similar (0.60 for subacute care and 0.57 for acute care) for both versions, but negative predictive values were >0.80.

Conclusions:

Model performances across care settings and criteria versions were generally poor but had reasonably high negative predictive value. Many patients in the subacute-care setting, an increasing fraction of CDI cases, could not be classified. More work is needed to develop criteria to identify patients at risk of poor outcomes.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION: Selected results from this manuscript were presented as a poster at IDWeek 2018 on October 4, 2018, in San Francisco, California.

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