S1084 Patient Characteristics and In-Hospital Outcomes of Clostridium difficile Infection in Patients With Liver Cirrhosis

Abstract

INTRODUCTION: Clostridium difficile infection (CDI) is exponentially increasing among hospitalized patients and has become one of leading cause of gastrointestinal death. Patients with Liver Cirrhosis (LC) have low immunity response and are frequently administered chronic antimicrobial therapies which increases risk of CDI among LC patients. The aim of this study is to examine clinical characteristics and outcomes of CDI patients with LC. METHODS: We queried Nationwide Inpatient Sample database from October2015 – December 2017 using ICD-10-CM codes to identify adult patients with CDI and LC (Age ≥ 18 years). SAS 9.4 was used for analysis to determine baseline characteristics, Elixhauser comorbidities & outcomes among CDI patients with LC with non-LC groups. Further, Multivariate logistic regression analysis was performed to analyze adjusted mortality. RESULTS: Among 761,230 patients with CDI, 36,705 (4.8%) had concomitant LC. Male gender was prominent among CDI with LC patients (54.8%) while Female in non-LC group (58.2%, P < 0.0001). CDI Patients with LC were younger (60.5 vs 66.3, P < 0.0001) with majority belonging to age 45-64 years (52.8%) while non-LC patients were mainly in age 65-84 years (44.9%, P < 0.0001). CDI with LC patients reported significantly more prevalence of comorbidities as alcohol abuse (25.8% vs 3.6%,P < 0.0001) and coagulopathy (36.9% vs 8.6%,P < 0.0001), and significant higher complications such as ascites(20.8% vs 2.5%,P < 0.0001) and peritonitis(6.2% vs 1.7%,P < 0.0001). Outcomes showed significantly higher in-hospital mortality(9.4% vs 6.1%,P < 0.0001; adjusted OR(95% CI): 1.87(1.78–1.97), P < 0.0001),longer median length of stay (7 vs 6 days, P = 0.003), higher median hospitalization cost (14403 vs 11485 $, P < 0.0001) & lower transfer to facility (28.5% vs 33.9%,P < 0.0001) in CDI patients with LC. CONCLUSION: CDI patients with LC reported higher comorbidities and complications such as ascites, peritonitis, liver disease, alcohol abuse and coagulopathy. Presence of LC in CDI patients leads to higher mortality rate, longer length of stay & have higher hospitalization cost. More studies are required to be focused on management of CDI patients with LC.Table 1.: Patient-Level Characteristics of Clostridium difficile infection (CDI) with Liver Cirrhosis(LC) versus CDI patients without LCTable 2.: In-hospital Outcomes among Clostridium difficile infection (CDI) with Liver Cirrhosis(LC) versus CDI patients without LC