Emergency department eosinophil counts and mortality in Clostridium difficile: a multihospital retrospective cohort study.

Porto biomedical journal Pub Date : 2025-05-06 eCollection Date: 2025-05-01 DOI:10.1097/j.pbj.0000000000000292
Sarah Bella, Cosimo Laterza, Danielle Biggs, Brian Walsh, Caitlin Gaudio, Daniel Pacitto, Michael E Silverman
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Abstract

Background: Clostridium difficile (Clostridioides difficile) infection (CDI) is the most common nosocomial infection in the United States, with mortality rates approaching 25% within 2 months of diagnosis. While current guidelines focus on CDI management once systemic symptoms develop, limited research has explored early predictors of disease severity. Eosinophils play a key role in gut immunity, and prior studies suggest absolute eosinopenia may be associated with severe CDI. This study evaluates the relationship between initial emergency department eosinophil counts and in-hospital mortality, with secondary assessments of admission rates, length of hospital stay, vasopressor use, and the need for surgical intervention.

Methods: We conducted a retrospective cohort study across 3 hospitals from July 1, 2018, to September 1, 2019. Adult patients with a positive Clostridium difficile stool assay and a documented eosinophil count during their emergency department evaluation were included. Patients already on CDI treatment, those younger than 18 years, and those without eosinophil counts were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included admission rates, length of hospital stay, vasopressor use, and surgical intervention. Eosinophil counts were categorized 0.0 cells/μL (absolute eosinopenia) and >0.0 cells/μL. Odds ratios and relative risks were calculated with 95% confidence intervals.

Results: Among 326 patients, 56 had eosinophil counts of 0.0 cells/μL, while 270 had counts >0.0 cells/μL. Patients with eosinophil counts of 0.0 cells/μL had higher mortality (16% vs. 6%, OR: 2.98, 95% CI: 1.25-7.15), increased admission rates (87% vs. 57%, OR: 5.05, 95% CI: 2.23-11.41), and longer hospital stays (7.1 vs. 3.4 days, P < .001). No significant differences were observed in vasopressor use or surgical intervention.

Conclusions: An initial emergency department eosinophil count of 0.0 cells/μL is associated with increased mortality, admission rates, and prolonged hospital stays in CDI. Absolute eosinopenia may serve as an early prognostic marker for disease severity, warranting further prospective investigation.

急诊科嗜酸性粒细胞计数和艰难梭菌死亡率:一项多医院回顾性队列研究。
背景:艰难梭菌(clostridiides difficile)感染(CDI)是美国最常见的医院感染,诊断后2个月内死亡率接近25%。虽然目前的指南侧重于一旦出现系统性症状的CDI管理,但有限的研究探索了疾病严重程度的早期预测因子。嗜酸性粒细胞在肠道免疫中起关键作用,先前的研究表明,绝对的嗜酸性粒细胞减少可能与严重的CDI有关。本研究评估了急诊初期嗜酸性粒细胞计数与住院死亡率之间的关系,并对入院率、住院时间、血管加压药的使用和手术干预的必要性进行了二次评估。方法:2018年7月1日至2019年9月1日,在3家医院进行回顾性队列研究。在他们的急诊科评估中,艰难梭菌粪便检测阳性和嗜酸性粒细胞计数记录的成年患者被纳入。已经接受CDI治疗的患者、年龄小于18岁的患者和没有嗜酸性粒细胞计数的患者被排除在外。主要终点是住院死亡率。次要结局包括住院率、住院时间、血管加压药的使用和手术干预。嗜酸性粒细胞计数为0.0 cells/μL(绝对嗜酸性粒细胞减少),bb0为0.0 cells/μL。比值比和相对风险以95%置信区间计算。结果:326例患者中,嗜酸性粒细胞计数为0.0 cells/μL的有56例,计数为bb0 0.0 cells/μL的有270例。嗜酸性粒细胞计数为0.0细胞/μL的患者死亡率较高(16% vs. 6%, OR: 2.98, 95% CI: 1.25-7.15),住院率较高(87% vs. 57%, OR: 5.05, 95% CI: 2.23-11.41),住院时间较长(7.1 vs. 3.4天,P < 0.001)。在血管加压药的使用或手术干预方面没有观察到显著差异。结论:急诊初始嗜酸性粒细胞计数为0.0细胞/μL与CDI死亡率、住院率和住院时间增加有关。绝对嗜酸性粒细胞减少可作为疾病严重程度的早期预后标志,值得进一步的前瞻性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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