Waterlow score to predict patients at risk of developing Clostridium difficile-associated disease

Tanner, Judith; Khan, Debra; Anthony, Denis; Paton, John B

doi:10.1016/j.jhin.2008.11.017

Cited by 36 publications

(30 citation statements)

References 9 publications

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“…19 Previous authors have shown that the Waterlow score can be used to predict inpatient mortality and morbidity for selected groups of patients. 15,17 We have extended this work…”

Section: Discussionmentioning

confidence: 88%

“…Previous reports have suggested that the Waterlow score correlates with disease severity and outcome in acute surgical emergencies. [15][16][17] This study sought to establish whether this score might be an effective surrogate tool for assessing the severity of acute pancreatitis, risk of associated disease specific complications, need for escalation of treatment and, finally, mortality risk.…”

mentioning

confidence: 99%

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Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

Gillick

Elbeltagi

Bhattacharya

2016

annals

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Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients’ general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann–Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of disease severity, help clinicians with appropriate resource management and inform patients.

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“…19 Previous authors have shown that the Waterlow score can be used to predict inpatient mortality and morbidity for selected groups of patients. 15,17 We have extended this work…”

Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

Gillick

Elbeltagi

Bhattacharya

2016

annals

View full text Add to dashboard Cite

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“…[11][12][13] Prognostic risk modeling has been used less frequently for infectious diseases; however, a number of risk prediction scores have been created to identify risk for incident and recurrent CDI among hospitalized patients. [14][15][16][17][18][19] In contrast to previous efforts, our risk score was developed to predict risk upon admission specifically to aid in decision making and targeting of antimicrobial stewardship efforts. This simple, reliable, and accurate tool will enable antimicrobial stewardship programs to use combinations of predictors to estimate the probability that CDI will occur in the next six months, and to identify patients for whom intensive antimicrobial review and stewardship efforts may be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

Kuntz

Smith

Petrik

et al. 2016

TPJ

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“…Several scores have been created to identify hospitalized patients at risk for incident and recurrent CDI [12][13][14][15][16][17], but no risk prediction score has been developed to identify risk for incident CDI among ambulatory patients.…”

Section: Introductionmentioning

confidence: 99%

Predicting the risk of Clostridium difficile infection following an outpatient visit: development and external validation of a pragmatic, prognostic risk score

Kuntz

Johnson

Raebel

et al. 2015

Clinical Microbiology and Infection

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Increasing morbidity related to Clostridium difficile infection (CDI) has heightened interest in the identification of patients who would most benefit from recognition of risk and intervention. We sought to develop and validate a prognostic risk score to predict CDI risk for individual patients following an outpatient healthcare visit. We assembled a cohort of Kaiser Permanente Northwest (KPNW) patients with an index outpatient visit between 2005 and 2008, and identified CDI in the year following that visit. Applying Cox regression, we synthesized a priori predictors into a CDI risk score, which we validated among a Kaiser Permanente Colorado (KPCO) cohort. We calculated and plotted the observed 1-year CDI risk for each decile of predicted risk for both cohorts. Among 356 920 KPNW patients, 608 experienced CDI, giving a 1-year incidence of 2.2 CDIs per 1000 patients. The Cox model differentiated between patients who do and do not develop CDI: there was a C-statistic of 0.83 for KPNW. The simpler points-based risk score, derived from the Cox model, was validated successfully among 296 550 KPCO patients, with no decline in the area under the receiver operating characteristic curve: 0.785 (KPNW) vs. 0.790 (KPCO). The predicted risk for CDI agreed closely with the observed risk. Our CDI risk score utilized data collected during usual care to successfully identify patients who developed CDI, discriminating them from patients at the lowest risk for CDI. Our prognostic CDI risk score provides a decision-making tool for clinicians in the outpatient setting.

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Waterlow score to predict patients at risk of developing Clostridium difficile-associated disease

Cited by 36 publications

References 9 publications

Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts

Predicting the risk of Clostridium difficile infection following an outpatient visit: development and external validation of a pragmatic, prognostic risk score

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