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External validation of clinical prediction rules for complications and mortality following Clostridioides difficile infection

Author

Listed:
  • Catherine Beauregard-Paultre
  • Claire Nour Abou Chakra
  • Allison McGeer
  • Annie-Claude Labbé
  • Andrew E Simor
  • Wayne Gold
  • Matthew P Muller
  • Jeff Powis
  • Kevin Katz
  • Suzanne M Cadarette
  • Jacques Pépin
  • Louis Valiquette

Abstract

Background: Several clinical prediction rules (CPRs) for complications and mortality of Clostridioides difficile infection (CDI) have been developed but only a few have gone through external validation, and none is widely recommended in clinical practice. Methods: CPRs were identified through a systematic review. We included studies that predicted severe or complicated CDI (cCDI) and mortality, reported at least an internal validation step, and for which data were available with minimal modifications. Data from a multicenter prospective cohort of 1380 adults with confirmed CDI were used for external validation. In this cohort, cCDI occurred in 8% of the patients and 30-day all-cause mortality occurred in 12%. The performance of each tool was assessed using individual outcomes, with the same cut-offs and standard parameters. Results: Seven CPRs were assessed. Three predictive scores for cCDI showed low sensitivity (25–61%) and positive predictive value (PPV; 9–31%), but moderate specificity (54–90%) and negative predictive value (NPV; 82–95%). One model [using age, white blood cell count (WBC), narcotic use, antacids use, and creatinine ratio > 1.5× the normal level as covariates] showed a probability of 25% of cCDI at the optimal cut-off point with 36% sensitivity and 84% specificity. Two scores for mortality had low sensitivity (4–55%) and PPV (25–31%), and moderate specificity (71–78%) and NPV (87–92%). One predictive model for 30-day all-cause mortality [Charlson comorbidity index, WBC, blood urea nitrogen (BUN), diagnosis in ICU, and delirium] showed an AUC-ROC of 0.74. All other CPRs showed lower AUC values (0.63–0.69). Errors in calibration ranged from 12%- 27%. Conclusions: Included CPRs showed moderate performance for clinical use in a large validation cohort with a majority of patients infected with ribotype 027 strains and a low rate of cCDI and mortality. These data show that better CPRs need to be developed and validated.

Suggested Citation

  • Catherine Beauregard-Paultre & Claire Nour Abou Chakra & Allison McGeer & Annie-Claude Labbé & Andrew E Simor & Wayne Gold & Matthew P Muller & Jeff Powis & Kevin Katz & Suzanne M Cadarette & Jacques , 2019. "External validation of clinical prediction rules for complications and mortality following Clostridioides difficile infection," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-15, December.
    • Handle: RePEc:plo:pone00:0226672
    DOI: 10.1371/journal.pone.0226672
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    References listed on IDEAS

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    1. Ewout W Steyerberg & Karel G M Moons & Danielle A van der Windt & Jill A Hayden & Pablo Perel & Sara Schroter & Richard D Riley & Harry Hemingway & Douglas G Altman & for the PROGRESS Group, 2013. "Prognosis Research Strategy (PROGRESS) 3: Prognostic Model Research," PLOS Medicine, Public Library of Science, vol. 10(2), pages 1-9, February.
    2. Claire Nour Abou Chakra & Jacques Pepin & Stephanie Sirard & Louis Valiquette, 2014. "Risk Factors for Recurrence, Complications and Mortality in Clostridium difficile Infection: A Systematic Review," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    5. Claire Nour Abou Chakra & Jacques Pepin & Louis Valiquette, 2012. "Prediction Tools for Unfavourable Outcomes in Clostridium difficile Infection: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-8, January.
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