scholarly journals 163. Development of an Electronic Flagging Tool for Identifying Cardiac Device Infections: Insights from the VA CART Program

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S15-S15
Author(s):  
Archana Asundi ◽  
Maggie Stanislawski ◽  
Payal Mehta ◽  
Hillary Mull ◽  
Marin Schweizer ◽  
...  
Keyword(s):  
Electronic Device ◽  
Heart Association ◽  
High Morbidity ◽  
Operating Characteristics ◽  
Cardiac Device ◽  
Increased Sensitivity ◽  
Icd Codes ◽  
Nested Case Control ◽  
Integrated Service Network ◽  
Research Grant

Abstract Background Surveillance is an essential aspect of infection prevention. Despite the high morbidity and mortality associated with procedure-related Cardiac Implantable Electronic Device (CIED) infections, methods for identifying them are limited. The objective of this study was to develop an algorithm with electronic flags to facilitate detection of CIED infections in a large, multi-center cohort. Methods A sample of patients who underwent CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) program from FY 2007 to 2015 were included in the nested case–control study. After cohort creation, data from this review process were combined with electronic variables (e.g., microbiology orders, ICD 9/10 codes) to develop a preliminary algorithm that categorized patients as high, intermediate, or low risk of CIED infection. Results A total of 1,014 unique patients out of a cohort of 5,955 procedures underwent manual review. Among these cases, 59 CIED infections and 955 controls were identified. Electronic variables predictive of CIED infection included ICD 9/10 infection codes and microbiology orders (table). ICD 9/10 codes had excellent PPV for flagging infections but sensitivity was limited (47.5%, see figure). Adding microbiology order flags increased sensitivity but lowered specificity. Specificity in patients without either flag was outstanding (99%). Conclusion Absence of ICD 9/10 and microbiology orders is highly specific for ruling out CIED infections. The discriminatory abilities of the algorithm for intermediate probability flags (+microbiology/−ICD9/10) need improvement. In patients without ICD codes, at least microbiology orders should be used as a flag to streamline review of possible device infections. Refinement of this tool using other clinical flags may improve operating characteristics and clinical utility. Disclosures W. Branch-Elliman, Veterans’ Integrated Service Network Career Development Award: Investigator, Research grant. American Heart Association: Investigator, Research grant.

scholarly journals 1178. Cardiac Device Infection: Do We Follow the Guidelines?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S422-S422
Author(s):  
Sandhya Nagarakanti ◽  
Eliahu Bishburg ◽  
Anita Bapat
Keyword(s):  
Electronic Device ◽  
Tertiary Care ◽  
Extraction Procedure ◽  
Heart Association ◽  
Care Hospital ◽  
Cardiac Device ◽  
Device Infection ◽  
Microbiological Criteria ◽  
Pocket Infection ◽  
Work Up

Abstract Background Cardiovascular implantable electronic device (CIED) such as pacemaker (PPM) and automated implantable cardiac defibrillator (AICD) are commonly utilized in clinical practice. Definitions of device infection (DI) and guidelines for the work up and device extraction (DE) have been published by the American Heart Association and the Infectious Disease Society of America. Our objective was to evaluate whether the work up of DI as recommended was followed, and whether the device was extracted according to guidelines. Methods A retrospective review in a 680-bed tertiary care hospital. Adult patients (patients) >18 years. who were diagnosed as having a DI and had the device extracted between 2008 and 2017 were included. Data were collected on demographics, device duration, blood culture (BC), echocardiogram utilization, lead cultures (LC) and device pocket cultures, appropriateness of extraction as per guidelines. Results Ninety-five patients were included. Mean age 68 years (range 23–90). 67 (70%) were male. Devices included: AICD in 75 (79%), PPM in 20(21%). CIED was present <1 year prior to infection in 24(24%). Compliance with guidelines recommendation to draw blood cultures, obtain an echocardiogram and send lead cultures and device pocket cultures were seen in 100%, 90.5% and 49.4% and 67.7%, respectively. Criteria for extraction was met in 65/95 (69%); reason for extraction was a pocket infection in 16/65(24.6%), bacteremia in 49/65 (75%), infective endocarditis in 38/65(58%). Thirty (31.5%) had device extracted without meeting guidelines recommendation, in 17 a diagnosis of pocket infection but without microbiological criteria or clinical diagnosis. In 9 patients lead vegetations were seen but no cultures to support extraction. Mortality was seen in 4 patients, one during the extraction procedure. Conclusion In our institution, 1/3 of the patients diagnosed with DI had no indication for DE. Guidelines recommendation for CIED extraction should be followed as extraction could be associated with significant complications. In this study, overall compliance with guidelines work up recommendations were not consistently followed, especially LC and device pocket cultures. Disclosures All authors: No reported disclosures.

scholarly journals Lymphocyte Count and Serum PCT L ev els  Improve the Sensitivity of CURB-65 in Prediction of 30-day Mortality of Patients with Community-acquired Pneumonia

2019 ◽  
Author(s):  
Jin Zhang ◽  
Rui Tao ◽  
Pengcheng Liu ◽  
Dahai Zhao ◽  
Jiegou Xu
Keyword(s):  
Logistic Regression ◽  
Lymphocyte Count ◽  
Scoring System ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Diagnostic Model ◽  
High Morbidity ◽  
Operating Characteristics ◽  
Blood Biomarkers ◽  
Combined Models

Abstract Background Community-acquired pneumonia (CAP) is an infectious disease with high morbidity and mortality worldwide. The CURB-65 score and other blood biomarkers were used to evaluate prognosis of hospitalized patients with CAP. The aim of our study is t o evaluate the prognostic values of other blood biomarkers and the CURB-65 score in hospitalized patients with community-acquired pneumonia (CAP). Methods A retrospective study of clinical data of in-hospitalized adult CAP patients who fulfilled the CAP criteria and were admitted to the Second Affiliated Hospital of Anhui medical university between January 2015 and December 2018 was conducted. The CURB-65 score was calculated, and other biomarkers including blood lymphocyte countat and serum PCT (a propeptide of calcitonin) level were collected at enrolment. Logistic regression analysis was performed to develop combined models to predict 30-day mortality in overall hospitalized and/or the ICU admission of CAP patients. Then, receiver operating characteristics curve (ROC) analysis was conducted to measure and compare the prognostic values of the CURB-65 score and biomarkers in the combined models.Results The ROC curve analysis using logistic regression of the new combined models showed that the CURB-65 score combined with lymphocyte count and serum PCT level (designated as CURB-65L P) improved the predictive value and was sensitive diagnostic model in predicting the 30-day mortality of CAP patients.Conclusion Serum level of lymphocytes or PCT alone is a strong prognostic factor for evaluation of 30-day mortality of CAP patients. Incorporation of both factors improves the sensitivity of the CURB-65 scoring system in the prediction of the 30-day mortality. This new CURB-65LP scoring system is simple, but more accurate for evaluating the severity of CAP with higher sensitivity and specificity than the current CURB-65 scoring system.

Hope in Patients Hospitalized With Heart Failure

2005 ◽  
Vol 14 (5) ◽  
pp. 417-425 ◽  
Author(s):  
Tone Rustøen ◽  
Jill Howie ◽  
Ingrid Eidsmo ◽  
Torbjørn Moum
Keyword(s):  
Heart Failure ◽  
New York ◽  
Satisfaction With Life ◽  
Heart Association ◽  
Response Shift ◽  
High Morbidity ◽  
Class Iii ◽  
Control Subjects ◽  
Patients With Heart Failure ◽  
Comorbid Diseases

• Background Hope is seldom described in patients with heart failure, despite high morbidity and mortality for this population. • Objectives To describe hope in hospitalized patients with heart failure and to evaluate influences of demographic and health-related variables on hope. • Methods Ninety-three patients with heart failure and 441 healthy control subjects completed questionnaires about sociodemographics, health indices, disease severity, and the Herth Hope Index. • Results The patients with heart failure had a mean age of 75 years; 65% were men, and 47% lived alone. Lung diseases and diabetes were the most common comorbid diseases, with 58% classified as New York Heart Association class III. The mean global hope score among patients with heart failure was 37.69 (SD 5.3). Patients with skin (P = .01) and psychiatric (P = .02) disorders reported lower hope scores. Number of comorbid diseases was the only predictor of hope related to disease-specific variables (P = .01). Mean age of the control subjects was 60 years, and 66 (15%) lived alone. Once demographic variables were controlled for, patients with heart failure had significantly higher global hope scores than did control subjects. • Conclusions Adaptation to a life-threatening illness may induce a “response shift” that causes such patients to have more hope than the general population. Patients with heart failure may be more concerned with the past than the future. How patients judge their health and satisfaction with life influences their hope. Interventions supporting hope in patients with heart failure may influence treatment goals.

scholarly journals Persistent Cutibacterium (Formerly Propionibacterium) acnes Bacteremia and Refractory Endocarditis in a Patient with Retained Implantable Pacemaker Leads

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
M. Freedman ◽  
J. O. Aflatooni ◽  
R. Foster ◽  
P. G. Haggerty ◽  
C. J. Derber
Keyword(s):  
Electronic Device ◽  
Cardiac Pacemaker ◽  
Etiologic Agent ◽  
Implantable Devices ◽  
Blood Cultures ◽  
Cardiac Device ◽  
Pacemaker Leads ◽  
Lead Endocarditis ◽  
Positive Results ◽  
Implantable Pacemaker

Cutibacterium (formerly Propionibacterium) acnes (C. acnes) is a commensal bacteria commonly found on the human skin and in the mouth. While the virulence of C. acnes is low in humans, it does produce a biofilm and has been identified as an etiologic agent in a growing number of implant-associated infections. C. acnes infections can prove diagnostically challenging as laboratory cultures can often take greater than 5 days to yield positive results, which are then often disregarded as contaminant. Patients with recurrent bacteremia in the setting of implantable devices warrant further studies to evaluate for an associated valvular or lead endocarditis. The patient in this report demonstrates how cardiac device-related endocarditis secondary to C. acnes can be overlooked due to the indolent nature of this pathogen. This patient presented with an implanted cardiac pacemaker device, as well as retained leads from a prior pacemaker. Transesophageal echocardiography was required to confirm the diagnosis in the setting of multiple positive blood cultures and negative transthoracic echocardiograms over a period of 4 years. The purpose of this report is to highlight the difficulties encountered in diagnosing C. acnes endocarditis in a patient with a cardiac implantable electronic device and persistently positive blood cultures.

scholarly journals 746. Characteristics of Respiratory Syncytial Virus (RSV) Infection Among Hospitalized Adults, United States, 2014–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S268-S268 ◽  
Author(s):  
Lindsay Kim ◽  
Bryanna Cikesh ◽  
Pam Daily Kirley ◽  
Evan J Anderson ◽  
Seth Eckel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Syncytial Virus ◽  
Case Series ◽  
Chronic Obstructive ◽  
Medical Conditions ◽  
Research Support ◽  
Catchment Population ◽  
Icd Codes ◽  
Syncytial Virus ◽  
Research Grant

Abstract Background Respiratory syncytial virus (RSV) vaccines are in clinical development for older adults. We described RSV infections among adults requiring hospitalization and risk factors for severe outcomes using a population-based platform, the Influenza Hospitalization Surveillance Network (FluSurv-NET). Methods Surveillance occurred October 1–April 30 (2014–2017) at sites located in seven states (California, Georgia, Michigan, Minnesota, New York, Oregon, and Tennessee) covering an annual catchment population of up to 13 million adults ≥18 years. Laboratory-confirmed RSV cases were identified using hospital and state public health laboratories, hospital infection preventionists, and/or reportable condition databases. Medical charts were reviewed for demographic and clinical data. International Classification of Diseases (ICD) discharge codes were abstracted. Odds ratios (Oregon) and 95% confidence intervals (CIs) were determined to assess risk factors for ICU hospitalization and deaths. Results A total of 2,326 hospitalized RSV cases were identified. Over half were ≥65 years (62%, n = 1,438/2,326), female (59%, n = 1,362/2,326), white (70%, n = 1,301/1,855), and had ≥3 underlying medical conditions (52%, n = 1,204/2,326). 20% (n = 398/2,000) were hospitalized in the ICU (median length of stay, 3 days; interquartile range, 1–6 days), and 5% (n = 96/2,001) died in the hospital. Congestive heart failure (CHF; OR: 1.4, 95% CI: 1.1–1.8) and chronic obstructive pulmonary disease (COPD; OR: 1.3, 95% CI: 1.1–1.7) were associated with ICU admission, while age ≥80 years (OR: 4.1, 95% CI: 1.8–12.1) and CHF (OR: 2.4, 95% CI: 1.6–3.6) were associated with in-hospital deaths. RSV-specific ICD codes were listed in the first 9 positions in only 44% (879/1,987) of cases. Conclusion To our knowledge, this is the largest US case series of RSV-infected hospitalized adults. Most cases were ≥65 years and had multiple underlying medical conditions. Older age, CHF, and COPD were associated with the most severe outcomes. Few cases had RSV-specific ICD codes, suggesting that administrative data underestimate adult RSV-related hospitalizations. Continued surveillance is needed to understand the epidemiology of RSV among adults as vaccine products move toward licensure. Disclosures E. J. Anderson, NovaVax: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. AbbVie: Consultant, Consulting fee. MedImmune: Investigator, Research support. PaxVax: Investigator, Research support. Micron: Investigator, Research support. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

scholarly journals Multimodality Imaging in the Diagnostic Work-Up of Endocarditis and Cardiac Implantable Electronic Device (CIED) Infection

2020 ◽  
Vol 9 (7) ◽  
pp. 2237
Author(s):  
Nicola Galea ◽  
Francesco Bandera ◽  
Chiara Lauri ◽  
Camillo Autore ◽  
Andrea Laghi ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Electronic Device ◽  
Multimodality Imaging ◽  
Nuclear Imaging ◽  
Clinical Decision ◽  
Cardiac Device ◽  
Systemic Complications ◽  
Advantages And Disadvantages ◽  
Clinical Scenarios ◽  
Wide Range

Infective endocarditis (IE) is a serious cardiac condition, which includes a wide range of clinical presentations, with varying degrees of severity. The diagnosis is multifactorial and a proper characterization of disease requires the identification of the primary site of infection (usually the cardiac valve) and the search of secondary systemic complications. Early depiction of local complications or distant embolization has a great impact on patient management and prognosis, as it may induce to aggressive antibiotic treatment or, in more advanced cases, cardiac surgery. In this setting, the multimodality imaging has assumed a pivotal role in the clinical decision making and it requires the physician to be aware of the advantages and disadvantages of each imaging technique. Echocardiography is the first imaging test, but it has several limitations. Therefore, the integration with other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) becomes often necessary. Different strategies should be applied depending on whether the infection is suspected or already ascertained, whether located in native or prosthetic valves, in the left or right chambers, or if it involves an implanted cardiac device. In addition, detection of extracardiac IE-related lesions is crucial for a correct management and treatment. The aim of this review is to illustrate strengths and weaknesses of the various methods in the most common clinical scenarios.

Discriminative Ability and Reliability of Transesophageal Echocardiography in Characterizing Cases of Cardiac Device Lead Vegetations Versus Noninfectious Echodensities

2020 ◽  
Author(s):  
Merit P George ◽  
Zerelda Esquer Garrigos ◽  
Prakhar Vijayvargiya ◽  
Nandan S Anavekar ◽  
Sushil Allen Luis ◽  
...  
Keyword(s):  
Electronic Device ◽  
Control Group ◽  
Shape Descriptors ◽  
General Shape ◽  
Discriminative Ability ◽  
Cardiac Device ◽  
Microbiological Parameters ◽  
Lead Infection ◽  
Cardiovascular Implantable Electronic Device

Abstract Background Approximately one-third of cases of cardiovascular implantable electronic device (CIED) infection present as CIED lead infection. The precise transesophageal echocardiographic (TEE) definition and characterization of “vegetation” associated with CIED lead infection remain unclear. Methods We identified a sample of 25 consecutive cases of CIED lead infection managed at our institution between January 2010 and December 2017. Cases of CIED lead infection were classified using standardized definitions. Similarly, a sample of 25 noninfected patients who underwent TEE that showed a defined lead echodensity during the study period was included as a control group. TEEs were reviewed by 2 independent echocardiologists who were blinded to all linked patient demographic, clinical, and microbiological information. Reported echocardiographic variables of the infected vs noninfected cases were compared, and the overall diagnostic performance was analyzed. Results Descriptions of lead echodensities were variable and there were no significant differences in median echodensity diameter or mobility between infected vs noninfected groups. Among infected cases, blinded echocardiogram reports by either reviewer correctly made a prediction of infection in 6 of 25 (24%). Interechocardiologist agreement was 68%. Sensitivity of blinded TEEs ranged from 31.5% to 37.5%. Conclusions Infectious vs noninfectious lead echodensities could not be reliably distinguished on the basis of size, mobility, and general shape descriptors obtained from a retrospective blinded TEE examination without knowledge of clinical and microbiological parameters. Therefore, a reanalysis of criteria used to support a diagnosis of CIED lead infection may be warranted.

Prolonged Infusions of Low-Dose Thrombolytics in Elderly Patients With Prosthetic Heart Valve Thrombosis

2016 ◽  
Vol 23 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Sabahattin Gündüz ◽  
Mehmet Özkan ◽  
Mahmut Yesin ◽  
Macit Kalçık ◽  
Mustafa Ozan Gürsoy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Low Dose ◽  
Treatment Success ◽  
Prosthetic Heart Valve ◽  
Heart Association ◽  
Success Rates ◽  
Operating Characteristics ◽  
Valve Thrombosis ◽  
Slow Infusion

Background: The outcomes of thrombolytic therapy (TT) in elderly patients with prosthetic valve thrombosis (PVT) have not been evaluated previously. We investigated the outcomes of low-dose and slow infusion TT strategies in elderly patients with PVT. Methods: Twenty-seven (19 female) patients aged ≥65 years (median: 70 years, range: 65-82 years) were treated with repeated TT agents for PVT. The TT regimens included 24-hour infusion of 1.5 million units of streptokinase in 2 patients, 6-hour infusion of 25 mg recombinant tissue plasminogen activator (t-PA) in 12 patients, and 25-hour infusion of 25 mg t-PA in 13 patients. Treatment success and adverse event rates were assessed. Results: The initial and cumulative success rates were 40.7% and 85.2%, respectively. Adverse events occurred in 6 (22.2%) patients including 4 (14.8%) major (1 death, 1 rethrombosis, and 2 failed TT) and 2 (7.4%) minor (1 transient ischemic attack and 1 access site hematoma) events. Higher thrombus burden (thrombus area ≥1.1 cm2 by receiver operating characteristics analysis, sensitivity: 83.3%, specificity: 85%, area under the curve: 0.86, P = .008) and New York Heart Association class (0% vs 15.4% vs 25% vs 100% for classes I-IV, respectively, P = .02) predicted adverse events. By multiple variable analysis, thrombus area was the only independent predictor of adverse events (odds ratio: 13.8, 95% confidence interval: 1.02-185, P = .04). Conclusion: Slow infusion of low doses of TT agents (mostly t-PA) with repetition is successful and safe in elderly patients with PVT. However, excessive thrombus burden may predict adverse events.

scholarly journals Predictors of cardiac implantable electronic device infection in the United States

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Shah ◽  
V Modi ◽  
H Gandhi ◽  
H Thyagaturu ◽  
A Walker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Electronic Device ◽  
Univariate Analysis ◽  
The United States ◽  
Charlson Comorbidity Index Score ◽  
High Morbidity ◽  
Continuous Variables ◽  
Chi Square ◽  
Device Infection ◽  
Observation Period

Abstract Background Cardiac implantable electronic devices (CIED) are important tools for managing arrhythmias, improving hemodynamics, and preventing sudden cardiac death. Device infection (DI) remains a significant complication of CIED and is associated with high morbidity, mortality, and healthcare cost. Purpose To analyze predictors of DI and its in-hospital outcomes. Methods National Inpatient Sample 2011–2018 database was analyzed for admissions for CIED implantation or DI. Baseline and hospital level characteristics were derived. The Chi-square test and student t-test were used for comparison of categorical and continuous variables respectively. Variables with p&lt;0.20 from univariate analysis were included in the multivariate logistic regression to identify independent predictors of DI. Results A total of 1,604,173 admissions for CIED implantations and 71,007 (4.4%) admissions for DI were reported during 2011–2018. There was no significant change in annual admissions for DI (range 8550 to 9307, p for trend=0.98). Those with DI were more likely to be male (69.3 vs 57%, p&lt;0.001) and had higher Charlson comorbidity index score ≥3 (46.6%-vs-36.8%, p&lt;0.001). Multivariate analysis identified post-procedural hematoma (odds ratio (OR)=3.96; 95% Confidence Interval (CI)=3.46–4.54), congestive heart failure (CHF; OR=2.80, 95% CI=2.66–2.96), age group 45–60 years (OR=2.46, 95% CI=2.30–2.63), malnutrition (OR=1.99, 95% CI=1.85–2.15), coagulopathy (OR=1.75, 95% CI=1.64–1.86), end-stage renal disease (OR=1.65, 95% CI=1.53–1.78), atrial fibrillation (OR=1.42; 95% CI=1.35–1.49), non-Hispanic race (OR=1.25; 95% CI=1.16–1.36), coronary artery disease (OR=1.21; 95% CI=1.15–1.26), and thyroid disease (OR=1.15; 95% CI=1.09–1.12) [all p&lt;0.001] as independent predictors of DI. Prevalence of CHF, malnutrition, and atrial fibrillation increased in those admitted with DI over the observation period as shown in Figure 1 (p for trend &lt;0.001). Prevalence of diabetes mellitus also increased during the observation period although it was not an independent predictor of DI (p for trend &lt;0.001). Pulmonary embolism and deep vein thrombosis were most common complications in those with DI (4.1 and 3.6% respectively). Annual in-hospital mortality ranged from 3.9 to 5.7% (mean 4.4%, p for trend=0.07). Conclusion DI is relatively common and continues to be associated with high morbidity and mortality. Prevalence of DI has not changed significantly despite technical and technological advances in device implantation. Evaluation of risk factors for DI and management of modifiable comorbidities may be needed to reduce the incidence of this important complication of CIED implantation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Development and validation of a simple and robust model to predict 30-day mortality in patients with Clostridioides difficile-associated enterocolitis

2020 ◽  
Vol 7 (1) ◽  
pp. e000468
Author(s):  
Katrin Claudia Katzer ◽  
Stefan Hagel ◽  
Philipp Alexander Reuken ◽  
Tony Bruns ◽  
Andreas Stallmach
Keyword(s):  
Univariate Analysis ◽  
Mortality Prediction ◽  
University Hospital ◽  
Correct Prediction ◽  
High Morbidity ◽  
Healthcare Associated Infection ◽  
Operating Characteristics ◽  
Lower Systolic Blood Pressure ◽  
Training Cohort ◽  
Clostridioides Difficile

ObjectiveClostridioides difficile infection (CDI) is a common healthcare-associated infection and associated with high morbidity and mortality. As current guidelines recommend treatment stratified for disease severity, this study aimed to identify predictors of 30-day mortality in order to develop a robust prediction model.DesignThis was a retrospective analysis of 207 inpatients with CDI who were treated at the Jena University Hospital between September 2011 and December 2015. In a training cohort (n=127), predictors of 30-day mortality were identified by receiver operating characteristics analysis and logistic regression. The derived model was validated in an independent cohort of 80 inpatients with CDI.ResultsWithin 30 days, 35 (28%) patients in the training cohort died from any cause. C-reactive protein (CRP) of ≥121 mg/L (OR 3.80; 95% CI 1.64 to 7.80; p=0.003) and lower systolic blood pressure of ≤104 mm Hg (OR 3.73; 95% CI 1.63 to 8.53; p=0.002) at diagnosis as well as development of renal impairment (serum creatinine >1.5×baseline; OR 5.61; 95% CI 1.94 to 16.26; p=0.035) within the first 6 days were associated with 30-day mortality in univariate analysis. The use of these parameters enabled correct mortality prediction in 73% of cases on the day of diagnosis and in 76% at day 6. In the validation cohort, 30-day mortality was 18/80 (23%). Our model enabled a 73.7% correct prediction concerning 30-day mortality on day 6 after diagnosis of CDI.ConclusionHypotension and CRP elevation on the day of diagnosis as well as occurrence of kidney dysfunction during the first 6 days are suitable parameters to predict 30-day mortality in patients with CDI who need to be treated in the hospital.

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