Su1263 Clostridium difficile Infection Remains an Independent Risk Factor for Mortality and Colectomy in Hospitalized Patients With Ulcerative Colitis

Abstract

Background: Severe flares of ulcerative colitis (UC) requiring hospitalization are frequently associated with Clostridium difficile infection (CDI). Previous studies suggest an increase risk of colectomy (OR=2.5) and mortality (OR=4.7) in hospitalized patients with IBD and concomitant CDI (Inflamm Bowel Dis 2011; 17 and Gut 2008; 57). Over the past 5 years the utilization of vancomycin for CDI and biologics for UC has increased substantially. This study aimed to re-assess the relationship between UC and CDI using more recent data to identify whether outcomes have improved. Methods: We utilized the Nationwide Inpatient Sample, a database that collects discharge data from more than 7 million admissions annually from participating community hospitals. This data set represents 20 percent of the discharges from these hospitals. We identified patients hospitalized for the period 2007-2011. We restricted our analysis to patients aged 18 to 80, admitted under urgent or emergent conditions, with a diagnosis of ulcerative colitis with or without CDI, as indicated by ICD-9 coding. Rates of in-hospital mortality and colectomy were similarly ascertained. The study sample was weighted and analyzed using the Complex Samples Module of SPSS 22.0. Results: After weighting, 307,898 hospitalizations for UC were identified. Mean age was 51 ± 17.5 years; 53% female. There were 19,090 (6.2%) with concomitant CDI. The rate of colectomy in patients hospitalized with UC and CDI was 2.5%, compared with 0.6% in those without concomitant CDI (univariate odds ratio (OR) for colectomy 4.7, 95% CI= 4.2-5.1). In multivariate logistic regression, when adjusting for age, race, and gender, the OR remained highly significant at 5.1 (95% CI=4.5-5.8, p<0.001). The mortality rate in patients hospitalized with UC and CDI was 10.3%, compared with 1.5% in those without CDI (univariate OR for death 7.4 (95% CI=7.0-7.8, p<0.001). In multivariate logistic regression, when correcting for age, race, and gender, the OR similarly remained highly significant at 7.1 (95% CI=6.7-7.6, p<0.001). Conclusion: In this large, nationwide sample of patients hospitalized with ulcerative colitis, infection with CDI remains a highly significant independent risk factor for in-hospital mortality and colectomy. Our results are similar to previous reports indicating that there has been little change in outcomes despite advances in therapy for both diseases.