667 Comparison of Morbidity and Mortality in Ulcerative Colitis Patient Admissions With Cytomegalovirus and Clostridium difficile Infections

Abstract

INTRODUCTION: The incidence of ulcerative colitis (UC) is increasing throughout developed countries including the United States creating a significant economic burden. Clostridium difficile (C. diff) infection is a virulent pathogen commonly encountered in UC patients. Cytomegalovirus (CMV) infection is also well described in patients with severe UC, but its role as a pathogen is still evolving. Both infections have been associated with a poorer prognosis, especially in immunocompromised patients. Our study sought to compare rates of colectomy, length of stay (LOS) and inpatient mortality in UC patients admitted with flares compared to UC patients admitted with flares associated with either CMV or C. diff infection. METHODS: This was a retrospective cohort study using the 2011-2014 Nationwide Inpatient Sample (NIS) utilizing International Classification of Diseases, 9th Revision. Study included All patients above 18 years with principal or secondary discharge diagnoses of UC. Additional codes were utilized to identify CMV associated disease and presence of C. diff in the UC cohort. Outcomes included in-hospital mortality, LOS and colectomy rates between the UC cohorts (flare, CMV associated disease and C. diff). Proportions were compared using fisher's exact test and continuous variables using student t-test. Multivariable and Poisson regression was performed for length of stay and hospitalization charges. All statistics were performed utilizing STATA software. RESULTS: There were no gender differences between the three cohorts while the mean age of UC patients with CMV was 42.94 years compared to 46.96 and 46.63 years in UC flare and UC patients with C. diff, respectively (Table 1). Hispanics were more commonly found to have UC with CMV associated disease (14.07%) vs UC flare (9.61%) and UC with C. diff (10.59%) (P = 0.001). Steroid dependence was present in 6.53% of UC, 10.11% C. diff, and 18.11% of CMV flares (P = 0.001). Colectomy rates were 1.71%, 3.99% and 9.98% for UC, C. diff and CMV cohorts, respectively (P = 0.0001). LOS days was 4.71 in UC, 7.28 in C. diff, and 11.47 in CMV flares (P = 0001). In-patient mortality was 0.3%, 1.31% and 0.55% for UC, C. diff and CMV cohorts, respectively (P = 0.00001). CONCLUSION: This study demonstrates that patients admitted with UC flares associated with C. diff or CMV infection have higher morbidity and mortality than patients with UC flares alone. Immunocompromised patients should warrant a higher index of suspicion for these infections.