Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system.

Abstract

BACKGROUND:

The purpose of the study is to identify the risk factors of mortality and develop a risk scoring system in patients who underwent colectomy due to Clostridium difficile colitis (CD-C).

METHODS:

Patient information was extracted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data from 2012 to 2016. All adult patients who underwent colectomy for CD-C were included in the study. The data were split into training and testing data sets. A multiple logistic regression model was developed by backward deletion methods for risk assessment. To test the performance of the prediction model for 30-day mortality, a receiver operating characteristic (ROC) curve was generated and an area under the curve (AUC) was created.

RESULTS:

The training data set consisted of 434 (80%) patients, and the testing data set consisted of 91 (20%) patients. The overall mortality was 35%. No significant differences were found between the training and testing data sets for patient characteristics, comorbidities and mortality. The final model of the logistic regression model revealed a highly significant 30-day mortality for an age of ≥ 75 years old, ventilator dependency, Septic shock prior to surgery and a history of steroid use. The AUC value was 0.745 (95% CI 0.660-0.826). The risk of mortality scores range from 0 to 37. The highest score of 37 was related to an 83.9% predicted mortality.

CONCLUSION:

Older age, septic shock, ventilator dependency requiring supportive care and a history of chronic steroid use were highly associated with mortality. A nomogram showing the scores and their relationship to mortality may provide guidance to point of care physicians for deciding the goal of care.

LEVEL OF EVIDENCE:

Level of evidence: IV.

• Authors: Nasim Ahmed, Yen-Hong Kuo, Robyn K Guinto, Jordan Purewal
• Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society (Eur J Trauma Emerg Surg) Vol. 48 Issue 3 Pg. 2013-2022 (Jun 2022) ISSN: 1863-9941 [Electronic] Germany
• PMID: 34480588 (Publication Type: Journal Article)
• Copyright: © 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Steroids

Topics

• Adult
• Aged
• Clostridioides difficile
• Colitis (complications, surgery)
• Enterocolitis, Pseudomembranous (complications, surgery)
• Humans
• Retrospective Studies
• Risk Factors
• Shock, Septic
• Steroids