Acute kidney injury is an independent marker of severity in Clostridium difficile infection: a nationwide survey.
OBJECTIVE
To examine clinical outcomes in hospitalized Clostridium difficile infection (CDI) patients with acute kidney injury (AKI) using the National Hospital Discharge Survey for 2005 to 2009.


BACKGROUND
CDI can cause serious complications in hospitalized adults. On the basis of expert opinion, guidelines recommend AKI as a marker of severe CDI, but this has not been extensively validated.


METHODS
CDI and AKI patients were identified using International Classification of Diseases 9th edition codes. Weighted data analyses were performed to provide national estimates and compare outcomes in patients with AKI and CDI to CDI patients without AKI.


RESULTS
There were an estimated 1,261,712 patients with CDI identified with a median age of 75 years; 59.2% were female and 17.5% developed AKI. On multiple variable analysis, after adjusting for age, sex, and comorbid conditions, AKI was independently associated with length of hospital stay increase by 1.9 days, risk of colectomy with an odds ratio (OR) of 1.35, all-cause in-hospital mortality (OR, 2.76), and dismissal to a care facility (OR, 1.43), all P<0.0001.


CONCLUSIONS
These data support prior consensus opinion that AKI is an independent marker associated with adverse outcomes in CDI and provides key prognostic information.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA. khanna.sahil@mayo.edu
Sahil
S
Khanna
Mira T
MT
Keddis
Amit
A
Noheria
Larry M
LM
Baddour
Darrell S
DS
Pardi
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003015:Clostridium Infections / Q000150:complications*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D055815:Young Adult