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Volume 15, Number 3—March 2009

CME ACTIVITY - Research

Clinical Risk Factors for Severe Clostridium difficile–associated Disease

Timothy J. HenrichComments to Author , Douglas Krakower, Asaf Bitton, and Deborah S. Yokoe
Author affiliations: Brigham and Women’s Hospital, Boston, Massachusetts, USA (T.J. Henrich, D. Krakower, A. Bitton, D.S. Yokoe); Massachusetts General Hospital, Boston (D. Krakower); Harvard Medical School, Boston (Deborah S. Yokoe)

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Table 3

Univariate analysis results for 336 patients with and without severe CDAD, June 2005–May 2006*

Variable All patients, %† Severe CDAD, % (n = 41)‡ Nonsevere CDAD, % (n = 295) OR§ p value
Age >70 y 38.7 63.4 35.3 3.18 0.001¶
Female 48.2 51.2 47.8 1.15 0.807
Chemotherapy use§ 16.1 9.8 16.9 0.53 0.343
Corticosteroid use§ 25.6 31.7 24.7 1.41 0.444
Proton pump inhibitor use§ 63.7 61.0 64.1 0.88 0.832
H2 blocker use 32.1 34.1 31.9 1.11 0.909
Enteral feeding 21.7 26.8 21.0 1.38 0.520
Parenteral feeding 3.3 2.4 3.4 0.71 1.000
Cardiovascular disease 41.7 53.7 40.0 1.74 0.135
Pulmonary disease 19.3 24.4 18.6 1.41 0.508
Diabetes 22.6 22.0 22.7 0.96 1.000
Renal disease 22.0 19.5 22.4 0.84 0.831
Hemodialysis 6.0 4.9 6.1 0.79 1.000
Immunocompromised 17.3 4.9 19.0 0.22 0.044¶
Malignancy 46.9 39.0 47.1 0.72 0.420
Small bowel obstruction or ileus 8.3 19.5 6.8 3.33 0.014¶
Abnormal abdominal CT scan 28.3 78.0 21.4 13.09 <0.001¶
Prior hospitalization 39.9 56.1 37.6 2.12 0.036¶
SNF/rehabilitation stay 22.9 36.6 21.1 2.17 0.043¶
Max glucose level >150 mg/dL 49.1 70.7 46.1 2.83 0.005¶
ALT >40 U/L 23.1 28.2 22.3 1.37 0.540
Min albumin level <2.5 g/dL 27.7 59.0 22.8 4.89 <0.001¶
Max creatinine level >2 mg/dL 22.0 41.5 19.3 2.96 0.003¶
Max leukocyte count >20,000/μL 28.3 53.7 24.7 3.52 <0.001¶
Mean max leukocyte count × 103/μL 17.6 25.8 16.5 <0.001¶

*CDAD, Clostridium difficile–associated disease; OR, odds ratio; H2, histamine-2; CT, computed tomography; SNF, skilled-nursing facility; max, maximum; ALT, alanine aminotransferase; min, minimum.
†Total of 336 patients were included in analysis except for ALT (n = 286) and albumin (n = 295).
‡n = 39 for ALT and albumin.
§OR for severe CDAD in patients with positive C. difficile assay results; calculated for binary variables only (by χ2 or Fisher exact test) with exception of mean leukocyte count (significance calculated using Mann-Whitney test of ranked data).
¶Statistically significant at α = 0.05.

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