Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective.
OBJECTIVE
Clostridium difficile-associated disease (CDAD) is associated with antibiotic use, acid suppression, and hospitalization, all of which occur frequently in cirrhosis. The aim was to define the effect of CDAD on outcomes and identify risk factors for its development in cirrhosis.


METHODS
Case-control studies using the de-identified national (Nationwide Inpatient Sample, NIS) and an identified liver transplant center database of hospitalized cirrhotics with and without CDAD were performed. The NIS 2005 was queried for mortality, charges, and length of stay (LOS) in cirrhotics with/without CDAD. Outcomes of cirrhosis and infections were also analyzed. In the transplant center database, risk factors for CDAD were defined in hospitalized cirrhotics with/without CDAD who were age matched in a 1:2 ratio.


RESULTS
The NIS 2005 included 1,165 cirrhotics with and 82,065 without CDAD. Cirrhotics with CDAD had a significantly higher mortality (13.8% vs. 8.2%, P<0.001), LOS (14.4 days vs. 6.7 days, P<0.001), and charges ($79,351 vs. $35,686, P<0.001) compared with those without CDAD. On multivariate analysis, CDAD was associated with higher mortality (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.29-1.85), charges, and LOS despite controlling for cirrhosis complications and infections. In the transplant center database, 54 cirrhotics with and 108 cirrhotics without CDAD were included. Outpatient spontaneous bacterial peritonitis prophylaxis (35% vs. 13%, P=0.01), inpatient antibiotic (63% vs. 35%, P=0.0001), and proton pump inhibitor (PPI) use (74% vs. 31%, P=0.0001) were significantly higher in those with CDAD.


CONCLUSIONS
Cirrhotics with CDAD have a higher mortality, LOS, and charges on the NIS 2005 compared with those without CDAD. Antibiotic and PPI use are risk factors for CDAD development in hospitalized cirrhotics.
Department of Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, 23249, USA. jasmohan.bajaj@va.gov
Jasmohan S
JS
Bajaj
Ashwin N
AN
Ananthakrishnan
Muhammad
M
Hafeezullah
Yelena
Y
Zadvornova
Alexis
A
Dye
Emily L
EL
McGinley
Kia
K
Saeian
Douglas
D
Heuman
Arun J
AJ
Sanyal
Raymond G
RG
Hoffmann
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D016360:Clostridioides difficile; D015897:Comorbidity; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors