title: Comparison of clinical severity score indices for Clostridium difficile infection.
abstract: OBJECTIVE
  To compare 8 severity score indices for Clostridium difficile infection (CDI).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  This study was conducted from July through October 2006. All hospitalized patients in 3 university-affiliated hospitals with a positive fecal Clostridium difficile toxin assay result were evaluated. Infection was considered severe if patients had at least 1 of the following clinical events during their hospitalization: (1) death attributed to CDI within 30 days after diagnosis, (2) colectomy necessitated by CDI, or (3) intensive care unit admission for management of complications attributed to CDI. Severity was assessed on the basis of 8 severity score indices, using published criteria for severe CDI as the benchmark. The 8 severity score indices studied were Beth Israel, University of Pittsburgh Medical Center version 1, University of Pittsburgh Medical Center version 2, Hines VA, modified University of Illinois, University of Calgary version 1, University of Calgary version 2, and University of Temple.
  
  
  RESULTS
  Of 184 patients with CDI evaluated, 19 had severe cases and 165 had nonsevere cases, as assessed on the basis of the defined severe CDI criteria. Sensitivities of the 8 severity score indices studied ranged from 63.2% to 84.2%, and specificities ranged from 59.4% to 93.9%. The Hines VA index had the highest kappa score (0.69 [95% confidence interval, 0.54-0.83]), followed by the University of Pittsburgh Medical Center version 1 index. Independent risk factors for severe CDI determined by multivariate analysis were abdominal distention (P = .007), fever (temperature, 38.0°C or above; P = .042), white blood cell count of at least 20,000 cells/mm(3) (P = .035), and hypoalbuminemia (serum albumin level less than 3 mg/dL; P = .029).
  
  
  CONCLUSIONS
  The Hines VA CDI severity score index appeared to display the strongest correlation for predicting more severe forms of CDI.
authors: Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA. shigekifujitani@hotmail.com
authors: Shigeki
authors: S
authors: Fujitani
authors: W Lance
authors: WL
authors: George
authors: A Rekha
authors: AR
authors: Murthy
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000145:classification*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index