1063 Clostridioides difficile Infection in Liver Cirrhosis: A Multiyear Nationwide Analysis

Abstract

INTRODUCTION: For the past two decades, the incidence and severity of Clostridium Difficile Infection (CDI) have been increasing. Many risk factors have been identified in an effort to explain this phenomenon including broad-spectrum antibiotic therapy, prolonged hospitalization, immunosuppression, multiple comorbidities, and use of proton pump inhibitors (PPIs). Interestingly, all these factors occur frequently in patients with liver cirrhosis. METHODS: The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (2010-2014) was used for this analysis. Patients discharged with a diagnosis of cirrhosis and CDI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes (ICD-9-CM). Our primary outcomes were the prevalence of CDI and the effects of CDI on inpatient mortality. Our secondary outcomes were the length of stay and hospitalization charges. Categorical variables were compared using the chi-square test, and continuous variables were compared using student t-test. The analysis was performed with SPSS 25 (IBM, USA). RESULTS: Over the study period, a total of 738,199 patients with liver cirrhosis were identified. Among those, 15,791 had CDI. Cirrhosis patients with CDI and Cirrhosis patients without CDI had comparable mean age, sex, and race (Table 1). The prevalence of CDI was 2.1% among the cirrhosis population compared to 1.1% in the non-cirrhosis population with unadjusted OR of 1.95 (95% CI 1.92 to 1.98, P < 0.0001). CDI among patients with cirrhosis was associated with a higher mortality rate of 12.1% compared to 6.7% in cirrhosis-only patients (OR 1.91, 95% CI 1.82 to 2, P < 0.0001). The mean length of stay was higher in cirrhosis patients with CDI compared to cirrhosis-only patients (12.79 days vs 6.25 days, P < 0.0001). The mean hospitalization cost was also higher in cirrhosis patients with CDI ($117661.51 vs $56241.81, P < 0.0001). After adjustment for patient characteristics on a multivariable analysis (Table 2), CDI was independently associated with higher mortality among patients with cirrhosis (OR 1.88, 95% CI 1.79 to 1.97, P < 0.0001). CONCLUSION: The prevalence of CDI is higher for cirrhosis patients compared to non-cirrhotics. CDI among cirrhosis patients was associated with nearly twice the mortality rate compared to cirrhosis-only patients. Similarly, the mean length of stay and mean hospitalization cost were significantly higher in cirrhosis patients with CDI.