S226 Inpatient Outcomes of Clostridioides difficile Infection Among Patients With and Without Systemic Lupus Erythematosus

Abstract

Introduction: Patients with systemic lupus erythematosus (SLE) are generally known to have an increased risk of infection. However, there is a lack of studies exploring how SLE affects the outcomes of Clostridioides Difficile Infection (CDI). Thus, we aim to assess the outcomes of CDI in hospitalized patients with concomitant SLE. Methods: Patients hospitalized with CDI from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2014 were selected. Diagnoses were identified by using ICD-9 CM codes. Patient demographics and outcomes of CDI were compared between the groups with and without SLE. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, hypotension/shock, acute renal failure, ileus, megacolon, and colectomy. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. Multivariate logistic regression analysis was performed to determine if SLE is an independent predictor for the outcomes, adjusting for age, sex, race, Charlson Comorbidity Index, and CDI risk factors including obesity, inflammatory bowel disease, and cirrhosis. Results: Among 29,549 patients with CDI identified in the study, 332 patients had SLE. Among patients hospitalized with CDI, those with SLE were younger (53.8 vs 66.4, P < 0.05), more likely to be female (91.0% vs 63.9%, P < 0.05), less likely to White (55.7% vs 78.4%, P < 0.05), had lower Charlson Comorbidity Index (3.8 vs 4.2, P < 0.05), and had lower inpatient mortality (0.3% vs 1.8%, P < 0.05). There were no statistically significant differences in length of stay (6.7 days vs 6.2 days, P = 0.20) and total hospital charge ($45,884 vs $41,200, P = 0.17). Patients with SLE were more likely to be obese (14.6% vs 9.7%, P < 0.05). After adjusting for age, sex, race, Charlson Comorbidity Index, and CDI risk factors, patients with SLE were less likely to have hypotension/shock (aOR 0.45, 95% CI: 0.23-0.88, P < 0.05). The odds of acute renal failure, ileus, colectomy, and inpatient mortality were not statistically significant. Megacolon was omitted due to low prevalence in both groups. Conclusion: Our study indicates that SLE is an independent protective factor against hypotension/shock in patients hospitalized with CDI while there are no significant differences in other outcomes.Table 1.: Demographics on presentation for colon cancer in patients with and without HIV