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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 3

Cox proportional hazards estimate of deaths from Clostridium difficile–associated disease (CDAD) at 180 d in study cohort (N = 18,050; 2,299 deaths, 15,751 censored)*†

Variable Univariate hazard ratio‡ (95% CI) Multivariable hazard ratio‡ (95% CI)
CDAD 3.55 (3.37–3.75) 1.23 (1.03–1.46)
Male sex 1.73 (1.68–1.77) 1.17 (1.08–1.27)
White race
1.65 (1.61–1.70)
1.22 (1.11–1.33)
Modified APS
<2 Reference Reference
3–4 1.41 (1.36–1.47) 1.09 (0.96–1.24)
5–6 2.09 (2.00–2.17) 1.30 (1.14–1.49)
>7
4.11 (3.97–4.25)
1.65 (1.46–1.87)
Albumin, g/dL§
>3.5 Reference Reference
2.5–3.5 2.12 (1.90–2.36) 1.62 (1.45–1.82)
<2.5
4.77 (3.91–5.81)
2.93 (2.52–3.42)
Liver disease
None Reference Reference
Mild 3.08 (2.86–3.33) 2.37 (1.85–3.04)
Moderate to severe
5.50 (5.17–5.85)
3.76 (3.05–4.64)
Diabetes with chronic complications 1.47 (1.37–1.58) 1.49 (1.18–1.88)
Congestive heart failure 1.85 (1.80–1.91) 1.28 (1.15–1.42)
Cerebrovascular disease 1.68 (1.60–1.76) 1.62 (1.37–1.92)
Cancer, excluding leukemia or lymphoma 6.42 (6.24–6.61) 2.44 (2.15–2.76)
Leukemia or lymphoma 3.17 (2.99–3.38) 4.92 (3.98–6.08)
Metastatic solid tumor 8.82 (8.57–9.09) 4.41 (3.87–5.03)
HIV/AIDS 1.77 (1.62–1.95) 2.88 (2.12–3.91)
Paraplegia/ hemiplegia 1.75 (1.60–1.92) 1.53 (1.12–2.07)
Mechanical ventilation 6.39 (6.18–6.62) 3.17 (2.71–3.71)
ICU admission 3.08 (2.99–3.17) 1.31 (1.14–1.50)

*CI, confidence interval; APS, Acute Physiology Score; ICU, intensive care unit.
†Nonsignificant variables considered in the model included diabetes without chronic complications, chronic obstructive pulmonary disease, myocardial infarction, rheumatologic/collagen vascular disease and peptic ulcer disease. Of 2,299 people who died within 180 d of admission, 1,565 (68%) deaths were identified by means of the hospital Medical Informatics database and 734 (32%) were identified with the Social Security Death Index.
‡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).
§7,525 (43%) patients were missing albumin values. Values were imputed by using multiple imputation methods.

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