Defining Minor Intracerebral Hemorrhage

2021 ◽  
pp. 1-8
Author(s):  
Alejandra Gómez-González ◽  
Uxue Lazcano ◽  
Rosa Maria Vivanco-Hidalgo ◽  
Luis Prats-Sánchez ◽  
Daniel Guisado-Alonso ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
External Validation ◽  
Area Under The Curve ◽  
Cutoff Point ◽  
University Hospital ◽  
Minor Stroke ◽  
Operating Characteristics ◽  
Discovery Cohort ◽  
Definition Of ◽  
A Minor

<b><i>Background and Purpose:</i></b> The minor stroke concept has not been analyzed in intracerebral hemorrhage (ICH) patients. Our purpose was to determine the optimal cut point on the NIH Stroke Scale (NIHSS) for defining a minor ICH (mICH) in patients with primary ICH. <b><i>Methods:</i></b> An ICH was considered minor if associated with a favorable 3-month outcome (modified Rankin Scale score ≤2). For supratentorial ICH, the discovery cohort consisted of 478 patients prospectively admitted at University Hospital del Mar. Association between NIHSS at admission and 3-month outcome was evaluated with area under the curve-receiver operating characteristics (AUC-ROC) and Youden’s index to identify the optimal NIHSS cutoff point to define mICH. External validation was performed in a cohort of 242 supratentorial ICH patients from University Hospital Sant Pau. For infratentorial location, patients from both hospitals (<i>n</i> = 85) were analyzed together. <b><i>Results:</i></b> The best ­NIHSS cutoff point defining supratentorial-mICH was 6 (AUC-ROC = 0.815 [0.774–0.857] in the discovery cohort and AUC-ROC = 0.819 [0.756–0.882] in the external validation cohort). For infratentorial ICH, the best cutoff point was 4 (AUC-ROC = 0.771 [0.664–0.877]). Using these cutoff points, 40.5% of all primary ICH cases were mICH. Of these, 70.2% were living independently at 3-month follow-up (72% for supratentorial ICH and 56.1% for infratentorial ICH) and 6.5% had died (5.3% for supratentorial ICH, and 14.6% for infratentorial ICH). For patients identified as non-mICH, good 3-month outcome was observed in 11.3% of cases; mortality was 51%. <b><i>Conclusions:</i></b> The definition of mICH using the NIHSS cutoff point of 6 for supratentorial ICH and 4 for infratentorial ICH is useful to identify good outcome in ICH patients.

scholarly journals Multi-scale characterizations of colon polyps via computed tomographic colonography

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Weiguo Cao ◽  
Marc J. Pomeroy ◽  
Yongfeng Gao ◽  
Matthew A. Barish ◽  
Almas F. Abbasi ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Texture Features ◽  
Learning Model ◽  
Colon Polyps ◽  
Texture Descriptor ◽  
Operating Characteristics ◽  
Computed Tomographic ◽  
Multi Scale ◽  
Definition Of ◽  
Occurrence Matrix

AbstractTexture features have played an essential role in the field of medical imaging for computer-aided diagnosis. The gray-level co-occurrence matrix (GLCM)-based texture descriptor has emerged to become one of the most successful feature sets for these applications. This study aims to increase the potential of these features by introducing multi-scale analysis into the construction of GLCM texture descriptor. In this study, we first introduce a new parameter - stride, to explore the definition of GLCM. Then we propose three multi-scaling GLCM models according to its three parameters, (1) learning model by multiple displacements, (2) learning model by multiple strides (LMS), and (3) learning model by multiple angles. These models increase the texture information by introducing more texture patterns and mitigate direction sparsity and dense sampling problems presented in the traditional Haralick model. To further analyze the three parameters, we test the three models by performing classification on a dataset of 63 large polyp masses obtained from computed tomography colonoscopy consisting of 32 adenocarcinomas and 31 benign adenomas. Finally, the proposed methods are compared to several typical GLCM-texture descriptors and one deep learning model. LMS obtains the highest performance and enhances the prediction power to 0.9450 with standard deviation 0.0285 by area under the curve of receiver operating characteristics score which is a significant improvement.

scholarly journals Effectiveness of mid-regional pro-adrenomedullin (MR-proADM) as prognostic marker in COVID-19 critically ill patients: An observational prospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246771
Author(s):  
Giorgia Montrucchio ◽  
Gabriele Sales ◽  
Francesca Rumbolo ◽  
Filippo Palmesino ◽  
Vito Fanelli ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
University Hospital ◽  
Rank Test ◽  
Operating Characteristics ◽  
Icu Patients ◽  
Dying Patients ◽  
D Dimer ◽  
Over Time

Objective To test the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting mortality in COVID-19-ICU-patients. Methods All consecutive COVID-19 adult patients admitted between March and June 2020 to the ICU of a referral, university hospital in Northern-Italy were enrolled. MR-proADM and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Results 57 patients were enrolled. ICU and overall mortality were 54.4%. At admission, lymphocytopenia was present in 86% of patients; increased D-dimer and CRP levels were found in 84.2% and 87.7% of patients respectively, while PCT values > 0.5 μg/L were observed in 47.4% of patients. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes were different between surviving and non-surviving patients only. MR-proADM was higher in dying patients (2.65±2.33vs1.18±0.47, p<0.001) and a higher mortality characterized patients with MR-proADM >1.8 nmol/L (p = 0.016). The logistic regression model adjusted for age, gender, cardiovascular disease, diabetes mellitus and PCT values confirmed an odds ratio = 10.3 [95%CI:1.9–53.6] (p = 0.006) for MR-proADM >1.8 nmol/L and = 22.2 [95%CI:1.6–316.9] (p = 0.022) for cardiovascular disease. Overall, MR-proADM had the best predictive ability (AUC = 0.85 [95%CI:0.78–0.90]). Conclusions In COVID-19 ICU-patients, MR-proADM seems to have constantly higher values in non-survivor patients and predict mortality more precisely than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM in COVID-19 patients.

scholarly journals Time-to-Death Longitudinal Characterization of Clinical Variables and Longitudinal Prediction of Mortality in COVID-19 Patients: A Two-Center Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Anne Chen ◽  
Zirun Zhao ◽  
Wei Hou ◽  
Adam J. Singer ◽  
Haifang Li ◽  
...  
Keyword(s):  
Predictive Model ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
University Hospital ◽  
Clinical Markers ◽  
Operating Characteristics ◽  
Hospital Data ◽  
Temporal Characteristics ◽  
Clinical Variables ◽  
Prediction Of Mortality

Objectives: To characterize the temporal characteristics of clinical variables with time lock to mortality and build a predictive model of mortality associated with COVID-19 using clinical variables.Design: Retrospective cohort study of the temporal characteristics of clinical variables with time lock to mortality.Setting: Stony Brook University Hospital (New York) and Tongji Hospital.Patients: Patients with confirmed positive for severe acute respiratory syndrome coronavirus-2 using polymerase chain reaction testing. Patients from the Stony Brook University Hospital data were used for training (80%, N = 1,002) and testing (20%, N = 250), and 375 patients from the Tongji Hospital (Wuhan, China) data were used for testing.Intervention: None.Measurements and Main Results: Longitudinal clinical variables were analyzed as a function of days from outcome with time-lock-to-day of death (non-survivors) or discharge (survivors). A predictive model using the significant earliest predictors was constructed. Performance was evaluated using receiver operating characteristics area under the curve (AUC). The predictive model found lactate dehydrogenase, lymphocytes, procalcitonin, D-dimer, C-reactive protein, respiratory rate, and white-blood cells to be early predictors of mortality. The AUC for the zero to 9 days prior to outcome were: 0.99, 0.96, 0.94, 0.90, 0.82, 0.75, 0.73, 0.77, 0.79, and 0.73, respectively (Stony Brook Hospital), and 1.0, 0.86, 0.88, 0.96, 0.91, 0.62, 0.67, 0.50, 0.63, and 0.57, respectively (Tongji Hospital). In comparison, prediction performance using hospital admission data was poor (AUC = 0.59). Temporal fluctuations of most clinical variables, indicative of physiological and biochemical instability, were markedly higher in non-survivors compared to survivors (p &lt; 0.001).Conclusion: This study identified several clinical markers that demonstrated a temporal progression associated with mortality. These variables accurately predicted death within a few days prior to outcome, which provides objective indication that closer monitoring and interventions may be needed to prevent deterioration.

scholarly journals Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

2019 ◽  
Vol 1 (1) ◽  
pp. 13-21
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Imaging Modality ◽  
Low Cost ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Final Diagnosis ◽  
University Hospital ◽  
Operating Characteristics ◽  
Early Assessment

Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy. Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU. Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively. Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.

Prediction model for detecting circulating tumor DNA (ctDNA) in metastatic colorectal cancer (mCRC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3590-3590
Author(s):  
Allan Andresson Lima Pereira ◽  
Aparna Raj Parikh ◽  
Emily E. Van Seventer ◽  
Jingquan Jia ◽  
Jonathan M. Loree ◽  
...  
Keyword(s):  
Prediction Model ◽  
Metastatic Disease ◽  
Clinical Laboratory ◽  
External Validation ◽  
Area Under The Curve ◽  
Disease Status ◽  
Circulating Tumor Dna ◽  
Data Sets ◽  
Operating Characteristics ◽  
Node Metastases

3590 Background: While tissue-based assays have yields above 90% in solid tumors, there is less known about factors that influence the sensitivity of ctDNA for detecting mutations. Methods:We retrospectively evaluated mCRC patients (pts) who had plasma-derived NGS utilizing a highly-sensitive targeted 68-73-gene ctDNA assay. In a case-control design, pts with a known mutation on tissue and radiologic evidence of metastatic disease but no detectable ctDNA mutation were matched 1:3 with randomly selected pts with detectable mutations and compared according to clinical, laboratory, and radiologic characteristics. A prediction score for ctDNA detection was built using a binary logistic backward stepwise regression analysis and tested in two independent data sets from different institutions. Area under the curve (AUC) from receiver operating characteristics curves (ROC) were used for internal and external validation. Results: From 416 pts who met inclusion criteria, plasma-derived NGS did not find tumor mutations in 66 cases (15.9%); 198 pts with detectable alterations were selected as controls. After multivariate analysis, the detection of ctDNA was associated with increasing age (OR 1.05; 95%CI 1.02-1.09; p = .001), presence of liver (OR 5.82; 95%CI 2.55-12.49; p < .001) and lymph node metastases (OR 3.28; 95%CI 1.51-7.60; p = .004), archival TP53 mutations (OR = 2.88; 95%CI 1.37-6.17; p = .006). A key determinant was timing of collection relative to disease status: plasma collected in newly diagnosed metastatic disease or after evidence of progression was substantially more likely to have detectable alterations (OR 9.24; 95%CI 4.11-22.40; p < .001); The simplified prediction model performed well in internal (AUC = 0.88) and external validation (AUC = 0.95; 163 pts). Conclusions: Our validated prediction model provides clinicians and researchers with a tool to screen for patients in whom ctDNA testing can outperform tissue-based testing in detecting genomic alterations.

scholarly journals Fibrinogen–Albumin-Ratio is an independent predictor of thromboembolic complications in patients undergoing VA-ECMO

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sebastian Roth ◽  
Catrin Jansen ◽  
René M’Pembele ◽  
Alexandra Stroda ◽  
Udo Boeken ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Area Under The Curve ◽  
University Hospital ◽  
Youden Index ◽  
Thromboembolic Complications ◽  
Operating Characteristics ◽  
Albumin Ratio ◽  
Va Ecmo ◽  
The University ◽  
Ecmo Therapy

AbstractVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients suffering from refractory cardiogenic shock. Thromboembolic complications (TeC) are common in VA-ECMO patients and are associated with increased morbidity and mortality. Valid markers to predict TeC in VA-ECMO patients are lacking. The present study investigated the predictive value of baseline Fibrinogen–Albumin-Ratio (FAR) for in-hospital TeC in patients undergoing VA-ECMO. This retrospective cohort study included patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany between 2011 and 2018. Main exposure was baseline FAR measured at initiation of VA-ECMO therapy. The primary endpoint was the in-hospital incidence of TeC. In total, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. Receiver operating characteristics (ROC) curve of FAR for in-hospital TeC revealed an area under the curve of 0.67 [95% confidence interval (CI) 0.61–0.74]. Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds-ratio of 3.72 [95% CI 2.26–6.14] for the association between FAR and TeC. Baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, FAR might contribute to the prediction of TeC in this cohort.

scholarly journals Nomogram to Predict Cognitive Dysfunction After a Minor Ischemic Stroke in Hospitalized-Population

2021 ◽  
Vol 13 ◽  
Author(s):  
Li Gong ◽  
Haichao Wang ◽  
Xiaofeng Zhu ◽  
Qiong Dong ◽  
Qiuyue Yu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Scoring System ◽  
Validation Cohort ◽  
External Validation ◽  
Minor Stroke ◽  
Minor Ischemic Stroke ◽  
Stroke Center ◽  
A Minor

An easily scoring system to predict the risk of cognitive impairment after minor ischemic stroke has not been available. We aimed to develop and externally validate a nomogram for predicting the probability of post-stroke cognitive impairment (PSCI) among hospitalized population with minor stroke. Moreover, the association of Trimethylamine N-oxide (TMAO) with PSCI is also investigated. We prospectively conducted a developed cohort on collected data in stroke center from June 2017 to February 2018, as well as an external validation cohort between June 2018 and February 2019. The main outcome is cognitive impairment defined as &lt;22 Montreal Cognition Assessment (MoCA) score points 6 – 12 months following a minor stroke onset. Based on multivariate logistic models, the nomogram model was generated. Plasma TMAO levels were assessed at admission using liquid chromatography tandem mass spectrometry. A total of 228 participants completed the follow-up data for generating the nomogram. After multivariate logistic regression, seven variables remained independent predictors of PSCI to compose the nomogram included age, female, Fazekas score, educational level, number of intracranial atherosclerotic stenosis (ICAS), HbA1c, and cortical infarction. The area under the receiver-operating characteristic (AUC-ROC) curve of model was 0.829, C index was good (0.810), and the AUC-ROC of the model applied in validation cohort was 0.812. Plasma TMAO levels were higher in patients with cognitive impairment than in them without cognitive dysfunction (median 4.56 vs. 3.22 μmol/L; p ≤ 0.001). In conclusion, this scoring system is the first nomogram developed and validated in a stroke center cohort for individualized prediction of cognitive impairment after minor stroke. Higher plasma TMAO level at admission suggests a potential marker of PSCI.

scholarly journals The Feasibility of the Braden Scale for Assessing Pneumonia After Spontaneous Intracerebral Hemorrhage

2020 ◽  
Author(s):  
Yunlong Ding ◽  
Zhanyi Ji ◽  
Yingmin Zhao ◽  
Chunyan Wu ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Fasting Blood Glucose ◽  
Area Under The Curve ◽  
Cutoff Point ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Roc Curve Analysis ◽  
Braden Scale ◽  
Scale Scores ◽  
Grading Scale ◽  
The Mean

Abstract Background Stroke-associated pneumonia (SAP) is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage (ICH) and causes serious burdens. The six subscales of the Braden scale seem to be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of the Braden scale for predicting SAP after spontaneous ICH. Methods Patients with spontaneous ICH who were admitted to Jingjiang People’s Hospital and Zhoukou Central Hospital were retrospectively included and divided into two groups: the pneumonia and no pneumonia groups. The Braden scale and ICH-APS-A scale scores and demographic and clinical characteristics were collected, and the differences between the two groups were compared with statistical analyses. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive validity of the Braden scale for SAP after ICH. Results A total of 629 patients with ICH were included in this study, 150 (23.8%) of whom developed SAP. There were significant differences in age and fasting blood glucose level between the two groups, and the ICH-ASP-A score in the pneumonia group was significantly higher than that in the no pneumonia group (8.5 ± 3.9 vs 4.9 ± 3.2, P < 0.01). The mean score on the Braden scale in the pneumonia group was significantly lower than that in the no pneumonia group (16.5 ± 2.6, P < 0.01). The area under the curve (AUC) for the ICH-ASP-A score for the prediction of pneumonia after spontaneous ICH was 0.755 (95% CI = 0.712–0.798). When the cutoff point was 8 points, the sensitivity was 56.7% and the specificity was 77.5%. The AUC for the Braden scale for the prediction of pneumonia after ICH was 0.760 (95% CI = 0.717–0.804). When the cutoff point was 15 points, the sensitivity was 74.3% and the specificity was 64.7%. Conclusions The Braden scale is effective in predicting pneumonia after ICH. The Braden scale, with a cutoff point of 15 points, is a valid clinical grading scale for predicting SAP after spontaneous ICH.

scholarly journals 2636. Distinguishing Pertussis from Viral Mimickers: Development and Validation of a Clinical Prediction Score

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S921-S921
Author(s):  
Lamya Al-Barwani ◽  
Muna Al-Busaidi ◽  
Zaid Alhinai ◽  
Naema Al-Shibli
Keyword(s):  
Logistic Regression ◽  
Viral Infections ◽  
Conditional Logistic Regression ◽  
Laboratory Data ◽  
University Hospital ◽  
Symptom Duration ◽  
Operating Characteristics ◽  
Discovery Cohort ◽  
Sultan Qaboos University ◽  
Ethical Approval

Abstract Background Pertussis is often confused with respiratory viral infections, leading to misdiagnosis and overuse of antibiotics. Distinguishing the two entities more accurately can help optimize care. Methods We reviewed the charts of children under 18 years of age who presented to Sultan Qaboos University Hospital in Muscat, Oman and were tested for Bordetella pertussis by PCR between 2013 and 2018 (discovery cohort). Clinical and laboratory data were collected from the electronic patient record and analyzed. Backward conditional logistic regression was used to identify independent predictors of laboratory-confirmed pertussis cases. The Muscat Pertussis Index (MPI) score was developed based on the logistic regression model. The MPI score was retrospectively validated on a separate cohort of pediatric patients who presented to the Royal Hospital- Oman’s largest pediatric center- between 2017 and 2018, and were similarly tested for pertussis (validation cohort). Ethical approval of the study was obtained formally for both sites. Results 354 patients were enrolled in the discovery cohort. 196 (55%) were male, and the median age was 10 weeks (IQR, 6–16). 57 (16%) patients tested positive for B. pertussis by PCR, while 266 (75%) tested positive for respiratory viruses. 32 (9%) patients had both pertussis and a viral co-infection and 63 (18%) were negative for both. 255 (72%) patients received macrolide antibiotics. Younger age, fewer vaccine doses, contact with a sick adult, longer symptom duration, paroxysmal cough, cyanosis, post-tussive emesis, apnea, lymphocytosis and thrombocytosis were significantly associated with pertussis (Table 1). After logistic regression, independent predictors of pertussis were longer symptom duration, lymphocytosis, paroxysmal cough, lack of fever, cyanosis and age under 8 weeks. This formed the basis for creating the MPI score (Table 2). The MPI score was validated on a cohort of 122 patients. Higher MPI scores correlated significantly with confirmed pertussis cases (area under the receiver operating characteristics curve = 0.899, P < 0.001, Figure 1 and Table 3). Conclusion The majority of suspected pertussis cases were actually due to viral mimickers. The MPI score can predict likely cases of pertussis before laboratory confirmation. Future validation in more diverse settings would help expand its applicability. Disclosures All authors: No reported disclosures.

DistinguishingClostridium difficileRecurrence From Reinfection: Independent Validation of Current Recommendations

2017 ◽  
Vol 38 (8) ◽  
pp. 891-896 ◽  
Author(s):  
Ana Durovic ◽  
Andreas F. Widmer ◽  
Reno Frei ◽  
Sarah Tschudin-Sutter
Keyword(s):  
Treatment Effectiveness ◽  
External Validation ◽  
Extended Period ◽  
University Hospital ◽  
Predictive Values ◽  
Standard Definition ◽  
Pcr Ribotyping ◽  
Definition Of ◽  
Sensitivity Specificity ◽  
The University

OBJECTIVEDistinguishing recurrentClostridium difficileinfection (CDI), defined as CDI caused by the same genotype, from reinfection with a different genotype, has important implications for surveillance and clinical trials investigating treatment effectiveness. We validated the proposed 8-week period for distinguishing “same genotype CDI” from “different genotype CDI,” and we aimed to identify clinical variables with distinctiveness to propose an improved definition.METHODSFrom January 2004 to December 2013, a cohort of all inpatients with CDI at the University Hospital Basel, Switzerland, was established, and respective strains were collected. In patients with a second episode of CDI, both strains were compared using polymerase chain reaction (PCR) ribotyping. The standard definition of recurrence (within 8 weeks after initial diagnosis) was evaluated for its performance to predict CDI caused by the same genotype.RESULTSAmong 750 patients with CDI, 130 (17.3%) were diagnosed with recurrence or reinfection. Strains from both episodes were available from 106 patients. Identical strains were identified in 36 patients with recurrence (36 of 47) and 27 patients with reinfection (27 of 59). Sensitivity, specificity, and negative and positive predictive values of the standard definition were 56%, 74%, 53%, and 76%, respectively. An extended period of 20 weeks resulted in the best match for both sensitivity and specificity (83% and 58%, respectively), while none of the clinical characteristics revealed independent distinctive power.CONCLUSIONSOur results challenge the utility of the 8-week cutoff for distinguishing recurrent CDI from reinfection. An extended period of 20 weeks may result in improved overall performance characteristics, but this finding requires external validation.Infect Control Hosp Epidemiol2017;38:891–896

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