Construction of a diagnostic model for ulcerative colitis with Clostridioides difficile infection based on intestinal flora and metabolomics

WANG Zhuo; WAN Jian; ZHANG Yujie; HE Wenfang; WU Kaichun

doi:10.13276/j.issn.2097-1656.2024.03.015

Abstract：Objective To establish a diagnostic model for the presence of Clostridioides difficile(CD)infection in patients with ulcerative colitis(UC)based on clinical data,microorganisms and microbial metabolites.Methods Fifty-eight UC patients in Xijing Hospital,Air Force Medical University from 2018 to 2019 were included in this study and divided into UC group without CD infection(n =29)and UC group with CD infection(n =29).The differences in clinical data,flora and metabolites between the two groups were compared,and logistic regression analysis was used to establish a diagnostic model for the presence of CD infection in UC patients.The efficacy of the diagnostic model was evaluated by area under the receiver operating characteristic curve(AUC)and goodness-of-fit test.Results The results of univariate analysis showed that the fecal microbial metabolites hexadecane,lactic acid,coniferyl alcohol,3-phenyllactic acid,C-reactive protein,and Clostridium Ⅺ were associated with CD infection in UC patients(P<0.05),and the results of multivariate analysis showed that hexadecane,lactic acid,and Clostridium Ⅺ were independent predictors of the presence of CD infection in UC patients.A logistic regression model was established with 3 factors:logit(P)=0.724-0.980×hexadecane +1.512×lactic acid + 1.298×Clostridium Ⅺ.The AUC of this model was 0.873(95％CI:0.782-0.964),and the diagnostic threshold of this model was0.411 at the maximum of the Youden's index(0.655),with a sensitivity of 79.3％and a specificity of 86.2％.In Hosmer-Lemeshow test,x2 =5.381 and P was 0.716.Conclusion The clinical diagnostic model of CD infection in UC patients based on intestinal microorganisms and microbial metabolites has good efficacy and can provide reference for further clinical decision-making.