T2062 Proton Pump Inhibitors and Transplantation Are Important Risk Factors for the Development of Clostridium difficile Associated Disease in Hospitalized Patients

Abstract

Background and Aims: Acute gastroenteritis (GE) is an important risk factor for the development of irritable bowel syndrome (IBS). We utilized observational data from the Walkerton Health Study (WHS) to develop and validate a risk score for post-infectious (PI) IBS. Methods: Model derivation and validation were based on a split sample method from a cohort of patients with exposure to acute gastroenteritis (GE) (n=1368). Study participants were randomly assigned to the derivation and validation cohorts in a 1:1 ratio. Using the derivation cohort, univariate and multivariable logistic regression were used to identify risk factors associated with IBS. The risk model was validated in the validation cohort. Overall model performance was assessed using area under the receiver operating curve (ROC). The risk score was developed using multivariable regression coefficients obtained from the derivation set and validated in the validation set. Classification and Regression Tree (CART) modeling was used to determine the cut off values for the level of risk (high, intermediate and low) based on the total score. Results: Nine variables were identified as important predictors of IBS (gender, age<60, longer duration of diarrhea, increased stool frequency, abdominal cramping, bloody stools, weight loss, fever and psychological disorders (anxiety and depression)). The discriminatory power of the risk model based on the area under ROC was 0.70 and was similar in the validation set. The risk score model showed good accuracy in both the derivation and validation sets and was able to distinguish between cohorts at low, intermediate and high risk for developing PI-IBS. Percentages of patients with PI-IBS in the low, intermediate and high risk were 10%, 35% and 60% in the derivation cohort and 17%, 36% and 62% in the validation cohort. Conclusion: A simple risk tool that uses demographics and symptoms of acute GE can predict which patients with acute GE are at risk of developing PI-IBS. This tool may be used clinically to assess risk and guide treatment.