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Volume 14, Number 7—July 2008

Research

Attributable Outcomes of Endemic Clostridium difficile–associated Disease in Nonsurgical Patients

Erik R. Dubberke*Comments to Author , Anne M. Butler*, Kimberly A. Reske*, Denis Agniel*, Margaret A. Olsen*, Gina D’Angelo*, L. Clifford McDonald†, and Victoria J. Fraser*
Author affiliations: *Washington University School of Medicine, St. Louis, Missouri, USA; †Centers for Disease Control and Prevention, Atlanta, Georgia, USA;

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Table 2

Cox proportional hazards estimate of readmission at 180 d in Clostridium difficile–associated disease (CDAD) study cohort 
(N = 17,492; 4m207 readmissions, 13,285 censored)*†

Variable Univariate hazard ratio‡ (95% CI) Multivariable hazard ratio ‡ (95% CI)
CDAD 3.09 (2.95–3.23) 2.19 (1.87–2.55)
Male sex 1.42 (1.40–1.45) 1.11 (1.05–1.19)
White race
1.26 (1.23–1.28)
1.06 (1.00–1.13)
Modified APS
<2 Reference Reference
3–4 1.15 (1.12–1.18) 1.10 (1.02–1.20)
5–6 1.39 (1.35–1.43) 1.24 (1.13–1.35)
>7
1.84 (1.80–1.89)
1.50 (1.37–1.64)
Albumin, g/dL§
>3.5 Reference Reference
2.5–3.5 1.05 (1.03–1.08) 0.99 (0.92–1.08)
<2.5
1.03 (0.99–1.07)
0.95 (0.80–1.14)
Liver disease
None Reference Reference
Mild 1.80 (1.67–1.94) 1.44 (1.12–1.83)
Moderate to severe
1.79 (1.65–1.94)
1.48 (1.13–1.93)
Diabetes with chronic complications 1.89 (1.80–1.99) 1.53 (1.30–1.80)
Diabetes without chronic complications
1.29 (1.26–1.32)
1.10 (1.02–1.19)
Congestive heart failure 1.60 (1.56–1.64) 1.34 (1.23–1.45)
Cerebrovascular disease 0.77 (0.74–0.81) 0.74 (0.63–0.87)
Cancer, excluding leukemia or lymphoma 2.75 (2.67–2.83) 1.90 (1.70–2.13)
Leukemia or lymphoma 2.31 (2.18–2.45) 1.84 (1.52–2.23)
Metastatic solid tumor 2.81 (2.71–2.91) 1.66 (1.46–1.90)
HIV/AIDS 1.74 (1.62–1.87) 1.74 (1.38–2.19)
ICU admission 1.06 (1.03–1.09) 0.84 (0.76–0.93)

*CI, confidence interval; APS, Acute Physiology Score; ICU, intensive care unit.
†The analysis excluded 558 patients who died during the index hospital admission. Nonsignificant variables considered in the model included mechanical ventilation, paraplegia/hemiplegia, chronic obstructive pulmonary disease, myocardial infarction, rheumatologic/collagen vascular disease, and peptic ulcer disease.
‡Hazard ratios also adjusted for categorical age (<20, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, >95 y).
§7,610 (42%) patients were missing albumin values. Values were imputed by using multiple imputation methods.

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