Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients

K. Hornbuckle, A. Chak, H. M. Lazarus, G. S. Cooper, L. A. Kutteh, Rasim A. Gucalp, P. S. Carlisle, Joseph A. Sparano, P. Parker, R. A. Salata

Research output: Contribution to journalArticle

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Abstract

Background: Clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. Techniques for identifying infection often delay the initiation of therapy. Patients and methods: In this retrospective case- control analysis, we identified predictors for C. difficile-associated diarrhea in 29 patients hospitalized from 1988 to 1993 on a hematologic malignancy/bone marrow transplant unit (hospital A). We then validated our model with 58 C. difficile cases and 74 controls admitted to an oncology unit from a different institution (hospital B). Results: We found that low intensity of chemotherapy (P < 0.001), lack of parenteral vancomycin use (P = 0.03) and hospitalization within the past two months (P = 0.05) were independently predictive of C. difficile colitis by multivariate analysis. These variables were weighted for predictive capability using a receiver operator characteristic score; low intensity chemotherapy was assigned two points, lack of parenteral vancomycin received one point and prior hospitalization one point (P < 0.001 by χ2 for trend). The receiver operating characteristic (ROC) curve areas were 0.78 for patients at hospital A and 0.70 at hospital B indicating moderate drop off in discrimination. Compared to hospital A patients, hospital B patients hospitalized between 1989 and 1994 were more often women (P = 0.04), received less systemic vancomycin (P = 0.01), were less frequently neutropenic (P < 0.05), and received less intense chemotherapy regimens (P < 0.05). Despite these differences in demographics in patients between these institutions, our predictive model was validated in hospital B patients (P = 0.02 by χ2 for trend). Conclusions: The results of this study may help clinicians predict the risk of C. difficile disease in the hospitalized immunocompromised oncology patient and may help guide empiric therapy while awaiting results of stool toxin assays.

Original languageEnglish (US)
Pages (from-to)307-311
Number of pages5
JournalAnnals of Oncology
Volume9
Issue number3
DOIs
StatePublished - Mar 1998

Fingerprint

Clostridium difficile
Diarrhea
Vancomycin
Drug Therapy
Hospitalization
Colitis
Hospital Units
Immunocompromised Host
Hematologic Neoplasms
ROC Curve
Multivariate Analysis
Bone Marrow
Demography
Morbidity
Transplants
Therapeutics
Infection

Keywords

  • Antibiotic-associated diarrhea
  • C. difficile diarrhea
  • Diarrhea in cancer patients

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Hematology

Cite this

Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients. / Hornbuckle, K.; Chak, A.; Lazarus, H. M.; Cooper, G. S.; Kutteh, L. A.; Gucalp, Rasim A.; Carlisle, P. S.; Sparano, Joseph A.; Parker, P.; Salata, R. A.

In: Annals of Oncology, Vol. 9, No. 3, 03.1998, p. 307-311.

Research output: Contribution to journalArticle

Hornbuckle, K, Chak, A, Lazarus, HM, Cooper, GS, Kutteh, LA, Gucalp, RA, Carlisle, PS, Sparano, JA, Parker, P & Salata, RA 1998, 'Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients', Annals of Oncology, vol. 9, no. 3, pp. 307-311. https://doi.org/10.1023/A:1008295500932
Hornbuckle, K. ; Chak, A. ; Lazarus, H. M. ; Cooper, G. S. ; Kutteh, L. A. ; Gucalp, Rasim A. ; Carlisle, P. S. ; Sparano, Joseph A. ; Parker, P. ; Salata, R. A. / Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients. In: Annals of Oncology. 1998 ; Vol. 9, No. 3. pp. 307-311.
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abstract = "Background: Clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. Techniques for identifying infection often delay the initiation of therapy. Patients and methods: In this retrospective case- control analysis, we identified predictors for C. difficile-associated diarrhea in 29 patients hospitalized from 1988 to 1993 on a hematologic malignancy/bone marrow transplant unit (hospital A). We then validated our model with 58 C. difficile cases and 74 controls admitted to an oncology unit from a different institution (hospital B). Results: We found that low intensity of chemotherapy (P < 0.001), lack of parenteral vancomycin use (P = 0.03) and hospitalization within the past two months (P = 0.05) were independently predictive of C. difficile colitis by multivariate analysis. These variables were weighted for predictive capability using a receiver operator characteristic score; low intensity chemotherapy was assigned two points, lack of parenteral vancomycin received one point and prior hospitalization one point (P < 0.001 by χ2 for trend). The receiver operating characteristic (ROC) curve areas were 0.78 for patients at hospital A and 0.70 at hospital B indicating moderate drop off in discrimination. Compared to hospital A patients, hospital B patients hospitalized between 1989 and 1994 were more often women (P = 0.04), received less systemic vancomycin (P = 0.01), were less frequently neutropenic (P < 0.05), and received less intense chemotherapy regimens (P < 0.05). Despite these differences in demographics in patients between these institutions, our predictive model was validated in hospital B patients (P = 0.02 by χ2 for trend). Conclusions: The results of this study may help clinicians predict the risk of C. difficile disease in the hospitalized immunocompromised oncology patient and may help guide empiric therapy while awaiting results of stool toxin assays.",
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AU - Chak, A.

AU - Lazarus, H. M.

AU - Cooper, G. S.

AU - Kutteh, L. A.

AU - Gucalp, Rasim A.

AU - Carlisle, P. S.

AU - Sparano, Joseph A.

AU - Parker, P.

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AB - Background: Clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. Techniques for identifying infection often delay the initiation of therapy. Patients and methods: In this retrospective case- control analysis, we identified predictors for C. difficile-associated diarrhea in 29 patients hospitalized from 1988 to 1993 on a hematologic malignancy/bone marrow transplant unit (hospital A). We then validated our model with 58 C. difficile cases and 74 controls admitted to an oncology unit from a different institution (hospital B). Results: We found that low intensity of chemotherapy (P < 0.001), lack of parenteral vancomycin use (P = 0.03) and hospitalization within the past two months (P = 0.05) were independently predictive of C. difficile colitis by multivariate analysis. These variables were weighted for predictive capability using a receiver operator characteristic score; low intensity chemotherapy was assigned two points, lack of parenteral vancomycin received one point and prior hospitalization one point (P < 0.001 by χ2 for trend). The receiver operating characteristic (ROC) curve areas were 0.78 for patients at hospital A and 0.70 at hospital B indicating moderate drop off in discrimination. Compared to hospital A patients, hospital B patients hospitalized between 1989 and 1994 were more often women (P = 0.04), received less systemic vancomycin (P = 0.01), were less frequently neutropenic (P < 0.05), and received less intense chemotherapy regimens (P < 0.05). Despite these differences in demographics in patients between these institutions, our predictive model was validated in hospital B patients (P = 0.02 by χ2 for trend). Conclusions: The results of this study may help clinicians predict the risk of C. difficile disease in the hospitalized immunocompromised oncology patient and may help guide empiric therapy while awaiting results of stool toxin assays.

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KW - Diarrhea in cancer patients

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