S0829 Vitamin D Deficiency Associated With Clostridioides difficile Infection in Inflammatory Bowel Disease Admissions: Insights From the National Inpatient Sample Database

Abstract

INTRODUCTION: Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality in inflammatory bowel disease (IBD) population. Well established risk factors for CDI include recent hospitalization, long term use of antibiotics, and chronic immunosuppression. Additionally, recent reports suggest that vitamin D-deficiency plays an important role in CDI susceptibility. This study aimed to evaluate the relationship between vitamin D deficiency and CDI in patients admitted with IBD exacerbation. METHODS: We queried the National Inpatient Sample database 2006–2014. We selected patients with a primary diagnosis of ulcerative colitis (UC), Crohn’s disease (CD), or IBD-related complications using the appropriate ICD-9 codes. We identified patients with the diagnosis of intestinal CDI. Categorical variables were compared using Chi-square. Predictors of Vitamin D deficiency and CDI were evaluated by multivariate logistic regression. RESULTS: A total of 1,000,218 weighted discharges with a primary diagnosis of UC, CD, or IBD-related complications were analyzed. 36.3% of the cases had UC, 64% had CD and 0.7% had undetermined IBD. Among all the cases 6.1% had a diagnosis of CDI. Patients with CDI were older (53.8 years vs 45.9 years, P < 0.001) and predominantly female (59.5% vs 40.5% P < 0.001). Older age, female gender (aOR: 1.18, P < 0,001), diagnosis of UC, vitamin D deficiency (aOR: 1.73, P < 0,001), long-term use of steroids (aOR: 1.2, P < 0,001), and antibiotics (aOR: 3.02, P < 0,001) were independent predictors of CDI among the IBD population. Patients with CD (aOR: 0.66, P < 0,001), long-term use of ASA (aOR: 0.93, P = 0.006) and non-steroidal anti-inflammatory drugs (aOR:0.52, P < 0,001) were less likely to have CDI during hospitalization. CONCLUSION: Vitamin D is involved in innate and acquired immunity and plays an important role on gut health. The deficiency of vitamin D in IBD patients has been associated with increased disease activity and poor outcomes. Only a few studies have examined an association between vitamin D levels and susceptibility to CDI in the IBD population. The proposed mechanism is decreased levels of cathelicidin, an antimicrobial peptide that inhibits the effect of C difficile toxin, which production is stimulated by vitamin D. Our study showed that vitamin D deficiency is a predictor of CDI in patients admitted with IBD exacerbation. Its main implication is the potential impact vitamin D supplementation can play in reducing the rates of CDI among the IBD population.Figure 1.: Percentages of the type of IBD among discharges for IBD exacerbation from 2006 to 2014.Table 1.: Summary of demographic characteristics of all cases with a primary discharge diagnosis of IBD: Nationwide Inpatient Database from 2006 to 2014Table 2.: Independent predictors of CDI in patients with a primary discharge diagnosis of IBD: multivariate logistic regression analysis in the Nationwide Inpatient Database in 2006–2014