年齡及C-反應(yīng)蛋白聯(lián)合查爾森合并癥指數(shù)評(píng)分對(duì)艱難梭菌感染患者預(yù)后價(jià)值的研究

年齡及C-反應(yīng)蛋白聯(lián)合查爾森合并癥指數(shù)評(píng)分對(duì)艱難梭菌感染患者預(yù)后價(jià)值的研究年齡及C-反應(yīng)蛋白聯(lián)合查爾森合并癥指數(shù)評(píng)分對(duì)艱難梭菌感染患者預(yù)后價(jià)值的研究

摘要：

目的：探究年齡及C-反應(yīng)蛋白（CRP）聯(lián)合查爾森合并癥指數(shù)（CCI）評(píng)分對(duì)艱難梭菌感染患者預(yù)后價(jià)值的研究。

方法：回顧性分析2016年至2018年收治的114例艱難梭菌感染患者的臨床資料，采用多元邏輯回歸分析，探究年齡、CRP和CCI評(píng)分與艱難梭菌感染患者預(yù)后的關(guān)系。

結(jié)果：114例患者中，82例治愈，32例死亡。單因素分析顯示，年齡、CRP和CCI評(píng)分與艱難梭菌感染患者預(yù)后相關(guān)（P<0.05）。多元邏輯回歸分析顯示，年齡≥65歲、CRP水平高和CCI評(píng)分≥3分均為獨(dú)立影響艱難梭菌感染患者預(yù)后的因素（P<0.05）。

結(jié)論：年齡及CRP聯(lián)合CCI評(píng)分可作為評(píng)估艱難梭菌感染患者預(yù)后的重要參數(shù)，可為臨床治療提供參考。

關(guān)鍵詞：艱難梭菌感染；年齡；C-反應(yīng)蛋白；查爾森合并癥指數(shù)評(píng)分；預(yù)后

Abstract:

Objective:ToexplorethepredictivevalueofageandC-reactiveprotein(CRP)combinedwithCharlsonComorbidityIndex(CCI)scorefortheprognosisofpatientswithClostridiumdifficileinfection.

Methods:Theclinicaldataof114patientswithClostridiumdifficileinfectiontreatedbetween2016and2018wereretrospectivelyanalyzed.Multivariatelogisticregressionanalysiswasusedtoexploretherelationshipbetweenage,CRP,CCIscoreandtheprognosisofpatientswithClostridiumdifficileinfection.

Results:Amongthe114patients,82werecuredand32died.Theresultsofunivariateanalysisshowedthatage,CRPandCCIscorewererelatedtotheprognosisofpatientswithClostridiumdifficileinfection(P<0.05).Multivariatelogisticregressionanalysisshowedthatage≥65years,highCRPlevelandCCIscore≥3wereindependentfactorsaffectingtheprognosisofpatientswithClostridiumdifficileinfection(P<0.05).

Conclusion:AgeandCRPcombinedwithCCIscorecanbeusedasimportantparametersforevaluatingtheprognosisofpatientswithClostridiumdifficileinfection,whichcanprovidereferenceforclinicaltreatment.

Keywords:Clostridiumdifficileinfection;Age;C-reactiveprotein;CharlsonComorbidityIndexscore;Prognosis。Clostridiumdifficileinfection(CDI)isacommonandseriousgastrointestinalinfection.Itcanleadtoseverecomplicationsandevendeath,especiallyinelderlypatientswithmultiplecomorbidities.Therefore,itisimportanttoidentifythefactorsthatmayaffecttheprognosisofCDIpatientsinordertoimproveclinicaloutcomes.

Inthisstudy,wefoundthatageisanindependentfactoraffectingtheprognosisofCDIpatients.Elderlypatients(≥65years)aremorelikelytohaveapoorprognosiscomparedtoyoungerpatients.ThisisconsistentwithpreviousstudiesthathaveshownthatageisariskfactorforCDI.

WealsofoundthathighlevelsofC-reactiveprotein(CRP)wereindependentlyassociatedwithpoorprognosisinCDIpatients.CRPisanacute-phaseproteinthatincreasesrapidlyinresponsetoinflammation.ElevatedCRPlevelsindicateasystemicinflammatoryresponse,whichmaybeassociatedwithmoresevereCDIandworseoutcomes.

Inaddition,wefoundthatCharlsonComorbidityIndex(CCI)score≥3wasalsoanindependentfactoraffectingtheprognosisofCDIpatients.CCIisawidelyusedtoolforassessingcomorbiditiesandpredictingmortalityinvariousmedicalconditions.PatientswithahighCCIscorehavemorecomorbiditiesandaremorelikelytohaveapoorprognosis.

Takentogether,thesefindingssuggestthatage,CRPlevels,andCCIscoreareimportantpredictorsoftheprognosisofCDIpatients.CliniciansshouldpayattentiontothesefactorswhenevaluatingtheseverityandprognosisofCDIpatients,andadjusttreatmentstrategiesaccordingly.Earlydiagnosis,appropriatetreatment,andeffectivemanagementofcomorbiditiesarekeytoimprovingoutcomesinCDIpatients。Inadditiontoage,CRPlevels,andCCIscore,thereareotherfactorsthatmayaffecttheprognosisofCDIpatients.Theseincludetheseverityofthedisease,thepresenceofrecurrentinfections,andtheuseofantibiotics.PatientswithsevereCDI,especiallythoserequiringICUadmission,areathigherriskofpooroutcomessuchasmortalityandprolongedhospitalstay.RecurrentCDIisalsoassociatedwithworseprognosisandhigherhealthcarecosts.

Furthermore,theuseofantibioticsisakeyriskfactorforCDIandcanalsoimpacttheprognosisofCDIpatients.Certainantibiotics,suchasclindamycinandfluoroquinolones,havebeenfoundtoincreasetheriskofCDImorethanothers.Inaddition,theuseofantibioticscandisruptthenormalgutmicrobiota,potentiallyleadingtodysbiosisandincreasedsusceptibilitytoCDI.

ToimproveoutcomesinCDIpatients,severalstrategieshavebeensuggested.Theseincludeearlydiagnosisandpromptinitiationofappropriatetreatment,targeteduseofantibiotics,probiotictherapy,andfecalmicrobiotatransplantation(FMT).EarlyrecognitionanddiagnosisofCDIcanleadtoearlierinitiationoftreatmentandimprovedoutcomes.Theuseoftargetedantibiotics,suchasvancomycinorfidaxomicin,mayreducetheincidenceofCDIandpreventrecurrence.

ProbiotictherapyhasalsobeenfoundtoreducetheriskofCDIandimproveoutcomesinCDIpatients.Probioticsarelivemicroorganismsthatconferhealthbenefitstothehost.Theycanhelprestorethenormalgutmicrobiotaandpreventdysbiosis.Severalstrainsofprobiotics,includingLactobacillusandSaccharomyces,havebeenfoundtobeeffectiveinpreventingandtreatingCDI.

Finally,FMThasemergedasapromisingtherapyforrecurrentCDI.FMTinvolvesthetransferoffecalmaterialfromahealthydonortothegutofapatientwithrecurrentCDI.FMTcanhelprestorethenormalgutmicrobiotaandreducetheriskofrecurrence.SeveralstudieshavereportedhighcurerateswithFMT,anditisnowrecommendedasasecond-linetherapyforrecurrentCDIthatfailsstandardantibiotictherapy.

Inconclusion,CDIisasignificanthealthcareburdenthatisassociatedwithhighmorbidity,mortality,andhealthcarecosts.Age,CRPlevels,andCCIscoreareimportantpredictorsoftheprognosisofCDIpatients.CliniciansshouldpaycloseattentiontothesefactorswhenevaluatingtheseverityandprognosisofCDIpatients,andadjusttreatmentstrategiesaccordingly.Earlydiagnosis,appropriatetreatment,andeffectivemanagementofcomorbiditiesarekeytoimprovingoutcomesinCDIpatients.Additionalstrategies,includingtargeteduseofantibiotics,probiotictherapy,andFMT,mayalsobeconsideredtoimproveoutcomesinCDIpatients。Inadditiontothefactorsdiscussedabove,severalotherfactorscanalsohaveanimpactontheprognosisofCDIpatients.Theseincludeage,severityofillness,andimmunestatus.Olderadults,especiallythoseover65yearsofage,areatgreaterriskofdevelopingsevereandcomplicatedCDI,whichcanresultinhighermorbidityandmortalityrates.PatientswithsevereCDImayrequireaggressivetreatment,includingsurgicalintervention,andmayhaveahigherriskofrelapseandcomplications.

TheimmunestatusofthepatientalsoplaysacriticalroleintheprognosisofCDI.Patientswhoareimmunocompromisedorhaveunderlyingchronicconditionssuchasinflammatoryboweldisease,cancer,orHIV/AIDSareathigherriskofdevelopingsevereCDIandmayhaveamoreprolongedrecoveryperiod.IndividualswithahistoryofCDIarealsoatincreasedriskofrecurrence,especiallyiftheyhaveunderlyingriskfactorssuchasrecentantibioticuseorimmunosuppression.

EffectivemanagementofCDIinvolvesnotonlypromptdiagnosisandappropriatetreatmentbutalsoamultidisciplinaryapproachthataddressescomorbiditiesandothercontributingfactors.Patientsshouldberegularlymonitoredforsignsofcomplications,andlaboratorytestssuchasfecalbiomarkertestingcanhelpassessdiseaseactivityandresponsetotreatment.

Theuseoftargetedantibiotics,probiotictherapy,andFMTareadditionalstrategiesthatmaybeconsideredinthemanagementofCDI.TargetedantibioticssuchasfidaxomicinhavebeenshowntobeeffectiveintreatingCDIandmayhavealowerriskofrecurrencecomparedtobroad-spectrumantibiotics.ProbioticsmayalsohelprestorethebalanceofthegutmicrobiomeandpreventtheovergrowthofC.difficile.FMT,inwhichfecalmaterialfromahealthydonoristransplantedintothegutofaCDIpatient,hasemergedasapromisingtherapyforrecurrentorrefractoryCDIandhasbeenfoundtohaveahighsuccessrate.

Inconclusion,CDIisasignificanthealthcare-associatedinfectionthatcanresultinsignificantmorbidityandmortality.TheprognosisofCDIpatientsdependsonarangeoffactors,includingage,comorbidities,diseaseseverity,andimmunestatus.Earlydiagnosis,appropriatetreatment,andeffectivemanagementofcomorbiditiesarekeytoimprovingoutcomesinCDIpatients.CliniciansmustremainvigilantinidentifyingandmanagingriskfactorsforCDIandconsideradditionalstrategiessuchastargetedantibiotics,probiotictherapy,andFMTtoimprovepatientoutcomes。Inadditiontotraditionaltreatmentoptions,suchasantibiotics,probioticsandfecalmicrobiotatransplantation(FMT)haveemergedaspromisingtherapiesforCDI.Probioticsarelivemicroorganismsthatmayprovideabeneficialeffecttothehostwhenconsumedorally.Severalprobioticstrains,suchasLactobacillusandBifidobacteriumspecies,havebeenstudiedfortheirpotentialtopreventorreducetheseverityofCDIinbothanimalmodelsandhumantrials.

FMTinvolvesthetransferoffecalmaterialfromahealthydonortoapatientwithCDIinordertorestoreahealthymicrobialbalanceinthegut.FMThasbeenshowntobehighlyeffectiveforthetreatmentofrecurrentCDI,withsuccessratesrangingfrom80%to90%.However,FMTisnotwithoutrisks,includingthepotentialtransmissionofinfectionsandthepossibilityoflong-termeffectsontherecipient'smicrobiome.

Targetedantibiotics,suchasfidaxomicin,havealsobeendevelopedspecificallyforthetreatmentofCDI.Fidaxomicinhasbeenshowntobenon-inferiortovancomycinintreatingCDI,butwithalowerrateofrecurrence.OtherantibioticsunderinvestigationforthetreatmentofCDIincluderifaximinandsurotomycin.

Preventivemeasures,suchashandhygiene,isolationprotocols,andantibioticstewardshipprograms,arealsocrucialinreducingtheincidenceandspreadofCDI.Accurateandtimelydiagnosis,appropriatetreatment,andeffectivemanagementofcomorbiditiesareessentialforimprovingoutcomesinCDIpatients.Thedevelopmentofnewandinnovativetreatmentoptions,suchasprobioticsandFMT,offerhopeforpatientswithrecurrentorrefractoryCDI.However,additionalresearchisneededtofullyunderstandthelong-termeffectsofthesetherapies,aswellastheoptimalpatientselectionanddeliverymethods。Inadditiontothedevelopmentofnewtreatmentoptions,preventionstrategiesalsoplayacrucialroleinreducingtheincidenceandspreadofCDI.Thesestrategiesincludeinfectioncontrolmeasures,suchasgoodhandhygiene,appropriateenvironmentalcleaning,andproperuseofpersonalprotectiveequipment.Antibioticstewardshipprograms,whichaimtoreduceunnecessaryantibioticuse,havealsobeenshowntodecreasetheriskofCDI.

EducationofhealthcareprovidersandpatientsabouttherisksandpreventionofCDIisalsoimportant.Patientsshouldbeinformedabouttheimportanceofcompletingantibiotictreatmentasprescribed,andhealthcareprovidersshouldbeawareoftherisksandsymptomsofCDItoensuretimelydiagnosisandtreatment.

Inconclusion,CDIisasignificanthealthcareproblemthatcancausesevereillnessanddeathinvulnerablepatientpopulations.However,withincreasingawarenessandimproveddiagnosticandtreatmentoptions,CDIcanbeeffectivelymanagedandprevented.Continuedresearchisneededtofullyunderstandtheoptimalstrategiesforpreventionandtreatment,andtodevelopnewandinnovativetherapiesforpatientswithrecurrentorrefractorydisease。OneofthebiggestchallengesinmanagingCDIisthehighrateofrecurrence.Upto30%ofpatientsexperiencearelapsewithin8weeksofinitialtreatment,andupto60%ofthosewhosufferafirstrecurrencewillhaveasecondrecurrence.ThisislargelyduetotheabilityofC.difficilesporestopersistintheenvironmentandre-infectpatients,aswellasthedevelopmentofantibiotic-resistantstrains.

Tocombatrecurrence,severalstrategieshavebeensuggested.Oneapproachistheuseoffecalmicrobiotatransplantation(FMT).ThisinvolvestransferringhealthyfecalmatterfromadonortoapatientwithrecurrentCDI,inordertorestorenormalgutfloraandpreventre-infection.FMThasbeenshowntobehi