TY - JOUR
T1 - External validation of two prediction tools for patients at risk for recurrent Clostridioides difficile infection
AU - van Rossen, Tessel M.
AU - van Dijk, Laura J.
AU - Heymans, Martijn W.
AU - Dekkers, Olaf M.
AU - Vandenbroucke-Grauls, Christina M. J. E.
AU - van Beurden, Yvette H.
N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TMR was supported by The Netherlands Organization for Health Research and Development (ZonMw) grant Goed Gebruik Geneesmiddelen, project number 848016009. The funders had no role in the study design, data collection, and interpretation, or the decision to submit the work for publication. Publisher Copyright: © The Author(s), 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: One in four patients with primary Clostridioides difficile infection (CDI) develops recurrent CDI (rCDI). With every recurrence, the chance of a subsequent CDI episode increases. Early identification of patients at risk for rCDI might help doctors to guide treatment. The aim of this study was to externally validate published clinical prediction tools for rCDI. Methods: The validation cohort consisted of 129 patients, diagnosed with CDI between 2018 and 2020. rCDI risk scores were calculated for each individual patient in the validation cohort using the scoring tools described in the derivation studies. Per score value, we compared the average predicted risk of rCDI with the observed number of rCDI cases. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: Two prediction tools were selected for validation (Cobo 2018 and Larrainzar-Coghen 2016). The two derivation studies used different definitions for rCDI. Using Cobo’s definition, rCDI occurred in 34 patients (26%) of the validation cohort: using the definition of Larrainzar-Coghen, we observed 19 recurrences (15%). The performance of both prediction tools was poor when applied to our validation cohort. The estimated AUC was 0.43 [95% confidence interval (CI); 0.32–0.54] for Cobo’s tool and 0.42 (95% CI; 0.28–0.56) for Larrainzar-Coghen’s tool. Conclusion: Performance of both prediction tools was disappointing in the external validation cohort. Currently identified clinical risk factors may not be sufficient for accurate prediction of rCDI.
AB - Background: One in four patients with primary Clostridioides difficile infection (CDI) develops recurrent CDI (rCDI). With every recurrence, the chance of a subsequent CDI episode increases. Early identification of patients at risk for rCDI might help doctors to guide treatment. The aim of this study was to externally validate published clinical prediction tools for rCDI. Methods: The validation cohort consisted of 129 patients, diagnosed with CDI between 2018 and 2020. rCDI risk scores were calculated for each individual patient in the validation cohort using the scoring tools described in the derivation studies. Per score value, we compared the average predicted risk of rCDI with the observed number of rCDI cases. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: Two prediction tools were selected for validation (Cobo 2018 and Larrainzar-Coghen 2016). The two derivation studies used different definitions for rCDI. Using Cobo’s definition, rCDI occurred in 34 patients (26%) of the validation cohort: using the definition of Larrainzar-Coghen, we observed 19 recurrences (15%). The performance of both prediction tools was poor when applied to our validation cohort. The estimated AUC was 0.43 [95% confidence interval (CI); 0.32–0.54] for Cobo’s tool and 0.42 (95% CI; 0.28–0.56) for Larrainzar-Coghen’s tool. Conclusion: Performance of both prediction tools was disappointing in the external validation cohort. Currently identified clinical risk factors may not be sufficient for accurate prediction of rCDI.
KW - Clostridioides difficile
KW - Clostridium difficile
KW - prediction models
KW - prognostic factors
KW - recurrence
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85099221376&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/1756284820977385
DO - https://doi.org/10.1177/1756284820977385
M3 - Article
C2 - 33456500
SN - 1756-283X
VL - 14
JO - Therapeutic advances in gastroenterology
JF - Therapeutic advances in gastroenterology
ER -