Clostridium difficile Infection Is Associated With Poor Outcomes in End-Stage Renal Disea…

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Optimum timing of blood tests for monitoring patients with Clostridium difficile-associated diarrhea.

J Investig Med. 2010 Apr;58(4):621-4

Authors: Bhangu A, Czapran A, Bhangu S, Pillay D

OBJECTIVE: This study aimed to identify optimum timing of blood tests and suitable cutoff values when managing patients with Clostridium difficile-associated diarrhea (CDAD), in relation to early mortality. METHODS: Review of 204 patients treated as inpatients for a first episode of CDAD from January to December 2008. Differences in values during the first 7 days of CDAD for white cell count (WCC), albumin, C-reactive protein, and creatinine between those who died and survivors to 30 days were compared using Mann-Whitney U tests. Cutoff values were assessed using receiver operating characteristic curves. RESULTS: Overall 30-day mortality was 27% (n = 56/204). White cell counts were significantly higher in those who died on the first 3 days (P < 0.001, P = 0.015, and P = 0.001, respectively). Median WCC in those who died was 20 x 10(9)/L or greater on both days 1 and 2. Albumin was significantly different on day 1 only (P = 0.003); C-reactive protein, and creatinine did not differ significantly on any day. The highest WCC in the first 3 days produced an area under the curve of 0.718 (P < 0.001). A WCC cutoff at 20 x 10(9)/L or greater when compared with 15 x 10(9) or greater had a higher positive predictive value (0.46 vs 0.34) and specificity (0.82 vs 0.60) but a lower sensitivity (0.49 vs 0.65). Mortality rates in the 2 groups were 46% and 34%, respectively. CONCLUSIONS: White cell count in the first 3 days is the strongest serum predictor of mortality and should be routinely monitored. A WCC of 20 x 10(9)/L or greater may be the best cutoff value to objectively identify cases at higher risk of death.

PMID: 20224434 [PubMed - indexed for MEDLINE]

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Harbingers for Clostridium difficile-associated diarrhea.

J Investig Med. 2009 Jan;57(1):40-2

Authors: Pant C, Madonia PN, Jordan P, Manas K, Bass P

PURPOSE:: Recent research has recognized surrogate markers for Clostridium difficile-associated diarrhea (CDAD). Among the most consistently identified markers are the leukocyte count, platelet count, and albumin level. Previous investigators failed to exclude patients with hematologic disorders that may have confounded their results. Therefore, the exclusion of this subset from our study lends it a unique perspective. METHODS:: We undertook a retrospective review of inpatients at our institution that were diagnosed with nosocomial diarrhea and subsequently had a stool sample sent for C. difficile toxins A and B. Patients with major hematologic disorders were excluded. RESULTS:: A total of 77 C. difficile-positive patients and 91 C. difficile-negative patients were studied. Patients with CDAD had a significantly higher leukocyte and platelet count but a lower albumin level compared with patients without CDAD. CONCLUSION:: Our results support the conclusion of preceding studies that leukocytosis, thrombocytosis, and hypoalbuminemia are reliable clinical predictors for CDAD even after careful exclusion of confounding factors.

PMID: 19092680 [PubMed - indexed for MEDLINE]

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