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Performance of Clostridioides difficile infection severity scores and risk factors related to 30-day all-cause mortality in patients with cancer

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There are currently no standard definitions for assessing the severity of Clostridioides difficile infection (CDI) in cancer patients. We evaluated the performance of scoring systems for severity and analyzed risk factors for mortality in a cancer cohort.


We conducted an observational study in patients with cancer and CDI. We calculated the incidence of hospital-onset (HO-CDI) and community-onset health-care facility associated (CO-HCFA-CDI) episodes. We classified severity using five prognostic scales and calculated sensitivity, specificity, positive (PPV), and negative predictive values (NPV) for mortality and intensive care unit (ICU) admission. In addition, multivariate regression was performed to assess variables associated with mortality.


The HO-CDI and CO-HCFA-CDI incidence rates were 3.7 cases/10,000 patient-days and 1.9 cases/1,000 admissions, respectively. ESCMID criteria showed the higher sensitivity (97%, 95% CI; 85–100%) and NPV (98%, 95% CI; 85–100%), while ATLAS (≥ 6 points) had the highest specificity (95%, 95% CI; 90–98%) for 30-day all-cause mortality; similar performance was observed for ICU admission. Characteristics associated with fatal outcome were neutropenia (≤ 100 cells/ml) (aOR; 3.03, 95% CI; 1.05–8.74, p = 0.040), male gender (aOR; 2.90, 95% CI; 1.08–7.80, p = 0.034), high serum creatinine (aOR; 1.71, 95% CI; 1.09–2.70, p = 0.020), and albumin (aOR; 0.17, 95% CI; 0.07–0.42, p < 0.001).


Some of the current scales may not be appropriate to discriminate severity in patients with cancer. The variables in this study associated with unfavorable outcomes could be evaluated in prospective studies to develop prognostic scores that identify susceptible patients, especially in immunocompromised populations.

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The data that support the findings of this study are available from the corresponding author upon reasonable request.

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We would like to thank the Plan de Estudios Combinados en Medicina (PECEM) of the Faculty of Medicine, UNAM and the Consejo Nacional de Ciencia y Tecnología (CONACyT) in Mexico for the scholarship number 969627 provided to DDM.


No funding was received for conducting this study.

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Authors and Affiliations



Conceptualization: DDM, PZP FRB and DVC; Methodology: DDM, PZP FRB and DVC. Formal analysis and investigation; DDM, PZP, FRB, AMO and DVC. Writing-original draft preparation: DDM and DVC; Writing-review and editing: DDM, PZP, FRB, AMO and DVC. Supervision: DVC. Abreviations: DDM; Daniel-De-la-Rosa-Martinez, PZP; Paola Zinser-Peniche, FRB; Frida Rivera-Buendia, AMO; Alexandra Martin-Onraet, DVC; Diana Vilar-Compte.

Corresponding author

Correspondence to Diana Vilar-Compte.

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Ethics approval

The study was approved by the ethical committee of the Instituto Nacional de Cancerologia, Mexico City (No CEI/1420/19). In addition, part of these patients was included in a previously published case–control study.

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NA, this is a register study.

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De-la-Rosa-Martinez, D., Zinser-Peniche, P., Martin-Onraet, A. et al. Performance of Clostridioides difficile infection severity scores and risk factors related to 30-day all-cause mortality in patients with cancer. Support Care Cancer 31, 187 (2023).

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