Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Martijn P. Bauer; Marjolein P.M. Hensgens; Mark A. Miller; Dale N. Gerding; Mark H. Wilcox; Adam P. Dale; Warren N. Fawley; Ed J. Kuijper; Sherwood L. Gorbach

doi:10.1093/cid/cis340

Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Martijn P. Bauer^*, Marjolein P.M. Hensgens, Mark A. Miller, Dale N. Gerding, Mark H. Wilcox, Adam P. Dale, Warren N. Fawley, Ed J. Kuijper, Sherwood L. Gorbach

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

75 Citations (Scopus)

Abstract

Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95 confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95 CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95 CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95 CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.

Original language	English
Pages (from-to)	S149-S153
Journal	Clinical Infectious Diseases
Volume	55
Issue number	SUPPL.2
DOIs	https://doi.org/10.1093/cid/cis340
Publication status	Published - 1 Aug 2012
Externally published	Yes

Bibliographical note

Funding Information:
Potential conflicts of interest. S. L. G. is a part-time employee of Optimer Pharmaceuticals, receiving honoraria from and owning stock options in Cempra. M. M. is a consultant for Optimer Pharmaceuticals. D. N. G. holds patents licensed to ViroPharma for the treatment and prevention of CDI; is a consultant for ViroPharma, Optimer, Cubist, Merck, Pfizer, TheraDoc, Astellas, BioRelix, and Actelion; and holds research grants from GOJO, Merck, Optimer, Sanofi Pasteur, Eurofins Medinet, and ViroPharma. M. H. W. has received honoraria for consultancy work, financial support to attend meetings, and research funding from Astellas, Astra-Zeneca, Bayer, bioMerieux, Cerexa, Cubist, Nabriva, Novacta, Pfizer, Sanofi-Pasteur, Summit, The Medicines Company, and Viropharma. All other authors report no potential conflicts.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/cid/cis340

Cite this

Bauer, M. P., Hensgens, M. P. M., Miller, M. A., Gerding, D. N., Wilcox, M. H., Dale, A. P., Fawley, W. N., Kuijper, E. J., & Gorbach, S. L. (2012). Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis. Clinical Infectious Diseases, 55(SUPPL.2), S149-S153. https://doi.org/10.1093/cid/cis340

@article{000fa0163ca74155850e8cfe2ec1fb22,

title = "Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis",

abstract = "Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95 confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95 CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95 CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95 CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.",

author = "Bauer, {Martijn P.} and Hensgens, {Marjolein P.M.} and Miller, {Mark A.} and Gerding, {Dale N.} and Wilcox, {Mark H.} and Dale, {Adam P.} and Fawley, {Warren N.} and Kuijper, {Ed J.} and Gorbach, {Sherwood L.}",

note = "Funding Information: Potential conflicts of interest. S. L. G. is a part-time employee of Optimer Pharmaceuticals, receiving honoraria from and owning stock options in Cempra. M. M. is a consultant for Optimer Pharmaceuticals. D. N. G. holds patents licensed to ViroPharma for the treatment and prevention of CDI; is a consultant for ViroPharma, Optimer, Cubist, Merck, Pfizer, TheraDoc, Astellas, BioRelix, and Actelion; and holds research grants from GOJO, Merck, Optimer, Sanofi Pasteur, Eurofins Medinet, and ViroPharma. M. H. W. has received honoraria for consultancy work, financial support to attend meetings, and research funding from Astellas, Astra-Zeneca, Bayer, bioMerieux, Cerexa, Cubist, Nabriva, Novacta, Pfizer, Sanofi-Pasteur, Summit, The Medicines Company, and Viropharma. All other authors report no potential conflicts.",

year = "2012",

month = aug,

day = "1",

doi = "10.1093/cid/cis340",

language = "English",

volume = "55",

pages = "S149--S153",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "SUPPL.2",

}

TY - JOUR

T1 - Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

AU - Bauer, Martijn P.

AU - Hensgens, Marjolein P.M.

AU - Miller, Mark A.

AU - Gerding, Dale N.

AU - Wilcox, Mark H.

AU - Dale, Adam P.

AU - Fawley, Warren N.

AU - Kuijper, Ed J.

AU - Gorbach, Sherwood L.

N1 - Funding Information: Potential conflicts of interest. S. L. G. is a part-time employee of Optimer Pharmaceuticals, receiving honoraria from and owning stock options in Cempra. M. M. is a consultant for Optimer Pharmaceuticals. D. N. G. holds patents licensed to ViroPharma for the treatment and prevention of CDI; is a consultant for ViroPharma, Optimer, Cubist, Merck, Pfizer, TheraDoc, Astellas, BioRelix, and Actelion; and holds research grants from GOJO, Merck, Optimer, Sanofi Pasteur, Eurofins Medinet, and ViroPharma. M. H. W. has received honoraria for consultancy work, financial support to attend meetings, and research funding from Astellas, Astra-Zeneca, Bayer, bioMerieux, Cerexa, Cubist, Nabriva, Novacta, Pfizer, Sanofi-Pasteur, Summit, The Medicines Company, and Viropharma. All other authors report no potential conflicts.

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95 confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95 CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95 CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95 CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.

AB - Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95 confidence interval [CI], 1.63-3.21) and renal failure (RR, 2.52; 95 CI, 1.82-3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95 CI, 1.07-5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95 CI, 1.05-2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.

UR - http://www.scopus.com/inward/record.url?scp=84863677786&partnerID=8YFLogxK

U2 - 10.1093/cid/cis340

DO - 10.1093/cid/cis340

M3 - Article

C2 - 22752864

AN - SCOPUS:84863677786

SN - 1058-4838

VL - 55

SP - S149-S153

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - SUPPL.2

ER -

Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Abstract

Bibliographical note

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this