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Evaluation of a risk score to predict future Clostridium difficile disease using UK primary care and hospital data in Clinical Practice Research Datalink

Lookup NU author(s): Dr Laura WoodsORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2019, © 2019 GlaxoSmithKline Biologicals SA. Published with license by Taylor & Francis Group, LLC.We evaluated the applicability of a Clostridium difficile infection (CDI) risk index developed for patients at hospital discharge to identify persons at high-risk of CDI in a primary care population. This retrospective observational study used data from the UK Clinical Practice Research Datalink, linked with Hospital Episodes Statistics. The risk index was based on the following patient characteristics: age, previous hospitalizations, days in hospital, and prior antibiotics use. Individual risk scores were calculated by summing points assigned to pre-defined categories for each characteristic. We assessed the association of risk factors with CDI by multivariate logistic regression. The estimated CDI incidence rate was 4/10,000 and 2/10,000 person-years in 2008 and 2012, respectively. On an index with a maximal risk of 19, a cut-off for high risk of ≥7 had sensitivity, specificity and positive predictive values of 80%, 87% and 12%, respectively. A high-risk person had a ~ 35% higher risk of CDI than a low-risk person. Multivariate risk factor analysis indicated a need to reconsider the relative risk scores. The CDI risk index can be applied to the UK primary care population and help identify study populations for vaccine development studies. Reassessing the relative weights assigned to risk factors could improve the index performance in this setting.

Publication metadata

Author(s): Marley C, El Hahi Y, Ferreira G, Woods L, Ramirez Villaescusa A

Publication type: Article

Publication status: Published

Journal: Human Vaccines and Immunotherapeutics

Year: 2019

Volume: 15

Issue: 10

Pages: 2475-2481

Online publication date: 04/04/2019

Acceptance date: 24/02/2019

Date deposited: 19/05/2022

ISSN (print): 2164-5515

ISSN (electronic): 2164-554X

Publisher: Taylor and Francis Inc.


DOI: 10.1080/21645515.2019.1589288

PubMed id: 30945972


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Funder referenceFunder name
GlaxoSmithKline Biologicals SA