Kulaylat AS, et al. - Researchers aimed at constructing a model using clinical indices readily available at hospital admission, including peripheral eosinophil counts, to predict inpatient mortality in patients with Clostridium difficile infection (CDI). At the time of admission for C. difficile infection, peripheral eosinopenia is helpful in predicting higher inpatient mortality. In treating C. difficile infection, this frequent addition to an admission complete blood cell count is an inexpensive, widely available risk index.

Methods

• Researchers performed a cohort study of 2,065 patients admitted for CDI through the Emergency Department of 2 tertiary referral centers from January 1, 2005, to December 31, 2015.
• The patients formed a training and a validation cohort.
• On the basis of admission eosinophil count (0.0 cells/μL or >0.0 cells/μL), they stratified the sample.
• They used multivariable logistic regression to construct a predictive model for inpatient mortality as well as other disease-related outcomes.
• The primary outcome was inpatient mortality.
• The need for a monitored care setting, need for vasopressors, and rates of inpatient colectomy were included as the secondary outcomes.

Results

• This study included 2,065 patients; among these, 1,092 (52.9%) were women; mean (SD) age of the patients was 63.4 (18.4) years.
• Increased in-hospital mortality was evident for those with an undetectable eosinophil count at admission in both the training (odds ratio [OR], 2.01; 95% CI, 1.08-3.73; P=.03) and validation (OR, 2.26; 95% CI, 1.33-3.83; P=.002) cohorts in both univariable and multivariable analysis.
• Findings also showed association of undetectable eosinophil counts with indicators of severe sepsis, such as admission to monitored care settings (OR, 1.40; 95% CI, 1.06-1.86), the need for vasopressors (OR, 2.08; 95% CI, 1.32-3.28), and emergency total colectomy (OR, 2.56; 95% CI, 1.12-5.87).
• At admission, increasing comorbidity burden (for each 1-unit increase: OR, 1.13; 95% CI, 1.05-1.22) and lower systolic blood pressures (for each 1-mm Hg increase: OR, 0.99; 95% CI, 0.98-1.00) were identified as other significant predictors of mortality.
• In a subgroup analysis of patients presenting without initial tachycardia or hypotension, significantly increased odds of inpatient mortality were evident only among patients with undetectable admission eosinophil counts, but not among those with an elevated white blood cell count (OR, 5.76; 95% CI, 1.99-16.64).