Oral 71 C. difficile Associated Risk of Death Score (CARDS): A Novel Risk Score to Predict Mortality Among Hospitalized Patients With C. difficile Infection
Author insight from Zain Kassam MD, MPH, FRCPC, Massachusetts Institute of Technology
What’s new here and important for clinicians?
The Clostridium difficile Associated Risk of Death Score (CARDS) is a novel scoring scale to predict mortality among hospitalized patients with CDI. Additionally, CARDS may be useful to stratify CDI severity and compare outcomes over time and across settings using administrative data. Based on the 2011 Nationwide Inpatient Sample (NIS) database, the largest source of all-payer hospital discharge information in the United States, 343,982 hospitalizations with an associated diagnosis of CDI were identified, of which 8% died. Eight CARDS predictors were identified using multivariate analysis including: age, cardiopulmonary disease, malignancy, diabetes, inflammatory bowel disease, acute renal failure, liver disease and ICU admission. Mortality increased significantly as CARDS increased. CDI-associated mortality was 1% with CARDS of 0; 4% with CARDS of 5; 20% with CARDS of 10; 47% with CARDS of 15 and 100% with CARDS of 18. The CARDS predictive model performed better than a standard model with age, sex, Charlson co-morbidity index and ICU admission.
What do patients need to know?
Clostridium difficile infection (CDI) is the leading hospital inquired infection in North America and a major public health threat. Factors that predict CDI-associated mortality are important for individual patients with CDI as well as public health more broadly as they guide clinicians, epidemiologists and policy stakeholders. The Clostridium difficile Associated Risk of Death Score (CARDS) is a novel scoring scale to predict mortality among hospitalized patients with CDI and help clinicians identify high-risk patients that need closer monitoring. Also, CARDS may enable epidemiologists and policy stakeholders to follow trends in CDI severity across the United States.
Zain Kassam MD, MPH, FRCPC, Massachusetts Institute of Technology
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