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1) Did the patient have liver cirrhosis ?

Form E: Additional cased-based data enhanced protocol. ( to be combined with Form C of the light protocol ). *. Hospital code :. *. Patient counter :. *. Ward (Unit) Id :. *. Ward specialty ( see code list ):. *. Previous healthcare admission in the last 3 months :. Yes. No.

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1) Did the patient have liver cirrhosis ?

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  1. Form E: Additional cased-based data enhanced protocol (tobecombinedwith Form C ofthelightprotocol) * Hospital code: * Patient counter: * Ward (Unit) Id: * Ward specialty (seecodelist): * Previoushealthcareadmission in the last 3 months: Yes No Yes Unknown Unknown No Unknown No Unknown Unknown Yes, Hospital Yes, other No Yes Yes Unknown Unknown No Yes No No Yes Unknown Yes, onecourse Antibiotictreatment in the last 3 months: * Yes, multiple course No Non-fatal underlyingdisease (survivalat least 5 years) Physicalstatus(McCabe Score): * Ultimately fatal underlyingdisease (1-4 years) Rapidly fatal underlyingdisease (lessthan 1 year) Unknown Comorbidity: * 1) Didthepatienthavelivercirrhosis? 1) Didthepatienthavelivercirrhosis? * 2) Didthepatienthave NYHA class IV heartfailureoranginawhenthestool sample was collected? * 3) Didthepatienthavepulmonarydiseaseasdefined in thechronichealthpoints score of APACHE II? * 4) Didthepatientreceivechronicdialysis? Was thepatientimmunocompromisedasdefined in thechronichealthpoints score of APACHE II? * * Complicatedcourseof CDI: Yes, deathrelatedto CDI Mortality: Didthepatient die duringthecurrentadmission? = required * Yes, deathunrelatedto CDI Yes, relationshipto CDI unknown Form Version 0.4 * Nodeath Date ofhospitaldischarge/death (dd/mm/yyyy):

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