S0093 Clostridium difficile Infection in Patients With Chronic Pancreatitis: Comparison of Patient Characteristics and Outcomes

Abstract

INTRODUCTION: Patients with Chronic pancreatitis (CP) have high rates of unplanned recurrent hospitalizations. Long-term hospital stay significantly increases risk of Clostridium difficile infection (CDI) which is among leading cause of gastrointestinal death. The aim of this study is to examine clinical characteristics and outcomes of CP patients with CDI. METHODS: Nationwide Inpatient Sample database was queried from October 2015 to December 2017 using ICD 10 to identify patients with CP and CDI (age ≥18 years). SAS 9.4 was used for analysis to determine baseline characteristics, Elixhauser comorbidities & outcomes among CP patients with CDI and non-CDI groups. Further, multivariate logistic regression analysis was performed to analyze adjusted mortality. RESULTS: Among 159,615 CP patients, 4,550 (2.85%) had concomitant CDI. Female gender was higher among CP with CDI patients (53.3%), while male in non-CDI group (57.6%, P < 0.0001). A majority of CP patients in non-CDI group were <65 years age (87.7%) as compared to CDI (78.4%, P < 0.0001). Medicare (42.1%) was main form of insurance in CDI while Medicaid (31.4%, P < 0.0001) in non-CDI patients. CP with CDI patients reported significantly higher prevalence of comorbidities including diabetes mellitus, liver diseases, renal failure, weight loss, fluid & electrolyte disorders, and coagulopathy. Complications such as dehydration and electrolyte disorders (63.1% vs 39.2%), septicemia (5.2% vs 1.2%), ascites (4.2% vs 2.3%), hypoalbuminemia (2.6% vs 0.9%) were significantly higher in CDI group. While, alcohol abuse (30.9% vs 37.8%, P < 0.0001) and acute pancreatitis (35.9% vs 82.9%, P < 0.0001) were higher in non-CDI group. Outcomes showed significantly higher in-hospital mortality (0.8% vs 0.2%, P < 0.0001; adjusted OR(95% CI): 1.49 (1.04–2.13), P = 0.02), longer median length of stay (5 vs 3 days, P < 0.0001) ,higher median hospitalization cost (8802 vs 5921, P < 0.0001) & lower disposition to home (68.8% vs 85.1%, P < 0.0001) in CP patients with CDI. CONCLUSION: CP patients with CDI has higher comorbidities than non-CDI group. Presence of CDI in CP patients leads to higher mortality rate, longer length of stay and higher hospitalization cost. Future studies should be targeted towards prevention of CDI in patients with CP.Table 1.: Patient-Level Characteristics of Chronic Pancreatitis with Clostridium Difficile Infection (CDI) versus Chronic Pancreatitis with Non-CDITable 2.: In-hospital Outcomes among Chronic Pancreatitis with Clostridium Difficile Infection (CDI) versus Chronic Pancreatitis with Non-CDI