Sa1236 Effect of Statins on Clinical Characteristics and Treatment Outcome of Clostridium difficile-Associated Disease Among Inpatients Taking Proton Pump Inhibitors or Not

Abstract

G A A b st ra ct s in an inpatient cohort from Olmsted County, MN. Information on maximum change in serum creatinine (highest value compared to baseline over the past year) and WBC within 7 days of CDI diagnosis was obtained for three groups: pediatrics ( ,18 yrs old), adults (18-65), and the elderly (.65). Sensitivity (Se) and specificity (Sp) of various levels of WBC and creatinine ratio were estimated for predicting severe-complicated CDI, defined as need for ICU admission, colectomy, or death. Analysis of creatinine ratio in the pediatric population was not done due to a high proportion of missing baseline creatinine values. The cohort included 1446 patients (48.6% female, median age 62.5 yrs [range, 0.1-103.7]); 487 (33.7%) had severe-complicated CDI. A WBC .15 x10^9/L (the cut-off recommended in expert guidelines) had a similar Se and Sp for predicting severe-complicated CDI in pediatrics (Se= 54.5, Sp=78.8), adults (Se=53.7, Sp=73.2), and the elderly (Se=56.3, Sp=63.5). A serum creatinine ratio of 1.5 had a similar ability to predict severe-complicated CDI in adults (Se= 59.2, Sp=59.5) and the elderly (Se=61.9, Sp=54.1). Lowering the thresholds of WBC and creatinine ratio increased the Se but decreased the Sp for predicting severe-complicated CDI in all age groups. For example, lowering the WBC threshold to 12.5 or decreasing the creatinine threshold to 1.4 increases the Se by 10-18% with a similar decrease in Sp (Table 1). No optimal WBC or creatinine rise cut-offs to predict severe-complicated CDI were defined in this investigation. The current cut-off values according to expert guidelines performed similarly across age groups, but had relatively low sensitivities and specificities. For all age groups and for both WBC and creatinine rise, decreasing the cut-off value increased the sensitivity while decreasing the specificity; these variables should be considered as continuous predictors of complicated CDI, with higher values indicating higher risk. Values below the threshold values defined in current guidelines do not reliably exclude a significant risk of complicated CDI. Given the poor outcomes in patients with severecomplicated CDI and the recommendation that treatment be stratified by severity, a more sensitive predictor (lower WBC or creatinine cut-offs) may be more appropriate. Table 1. Sensitivities and specificities of peripheral leukocyte count and serum creatinine rise in predicting severe-complicated Clostridium difficile infection.