Prediction Model Incorporating Peripheral Eosinopenia as a Novel Risk Factor for Death after Hospitalization for Clostridioides difficile Infection

ABSTRACT Background and Aims Clostridioides difficile infection (CDI) is associated with a range of outcomes and existing prediction models for death among patients with CDI are imprecise. Peripheral eosinopenia has been proposed as a novel risk factor for death among patients with CDI but has not been incorporated into prediction models. This study aimed to develop and validate a prediction model for death among patients hospitalized with CDI that incorporated peripheral eosinopenia. Methods Eosinopenia was defined as 0 eosinophils/uL on the soonest peripheral blood draw within the 48-hour window of the CDI test (before or after). Adults were eligible for the study if they were hospitalized at any one of three large, unaffiliated hospital networks, tested positive for CDI by stool PCR and received appropriate anti-CDI treatment. Patients were followed for all-cause death for up to 30 days. Results There were 4,518 unique hospitalized adults with CDI included (2,142 derivation cohort and 2,376 validation cohort). All-cause 30-day mortality was 9% and 10% in the cohorts respectively. In the validation cohort, the factors most strongly associated with death were eosinopenia [adjusted OR (aOR) 2.49, 95% CI 1.77-3.50], albumin 1.5 mg/dL (aOR 2.55, 95% CI 1.86-3.49). A six variable clinical prediction model was developed that improved upon existing classification schemes for CDI severity (AUROC of 0.75 vs. 0.68). Conclusions Among adults hospitalized with CDI, peripheral eosinopenia was associated with increased risk of all-cause 30-day mortality. A prediction model incorporating peripheral eosinopenia was developed to improve care for hospitalized patients with CDI through risk stratification.