C. difficile Infection Among Inflammatory Bowel Disease Patients Is Associated with Medication Non-compliance and Endoscopic Extent of Disease
Bibliographic record
Abstract
Introduction: Inflammatory bowel disease (IBD) patients have long been recognized to be at higher risk for Clostridium difficile infection (CDI), but which disease attributes predispose them to CDI is not well established. We sought to chraracterize risk factors for CDI among IBD patients. Methods: In this retrospective case control study we identified IBD patients with CDI vs control IBD patients without CDI during the period January 2010 to July 2015 at UCLA-Olive View hospital. CDI diagnosis was obtained from microbiology records, and IBD patients identified first using ICD-9 codes and then confirmed by chart review. We collected patient characteristics including age, race, gender, smoking status, IBD diagnosis (Crohn's disease vs. Ulcerative Colitis), time since IBD diagnosis, endoscopy results, prior surgery, serologic testing (ESR, CRP), proton pump inhibitor (PPI) use, and hospitalization or antibiotic use within the past three months. Results: We had a total of 82 patients: 28 cases and 54 controls. Median patient age was 40; nearly 60% were male, greater than 33% Hispanic, and 40% with diagnosis of Crohn's disease. Using SAS 9.4 we modeled the outcome of CDI with generalized linear modeling, and found that after controlling for PPI use and hospitalization or antibiotic use within 3 months, CDI was significantly associated with non-compliance to medical therapy for IBD (OR 7.1, p=0.01, 95% CI 1.5-32). Notably, this effect was independent of which type of medication (ASA compound, TNF, prednisone) patients were previously taking. Further, medication non-compliance could be substituted in our model for Montreal classification of endoscopic results, where more extensive disease involvement (L2 or L3 for Crohns, E2 or E3 for UC) was associated with CDI. Among patients with Crohn's disease, no CDI cases had isolated ileal involvement. Conclusion: Our study suggests that the risk of CDI among IBD patients may be linked to greater extent of disease at baseline and to poorer adherence to therapy although larger, prospective studies are needed to confirm this.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".