title: Effects of Clostridium difficile infection in patients with alcoholic hepatitis.
abstract: OBJECTIVE
  Infection increases mortality in patients with alcoholic hepatitis (AH). Little is known about the association between Clostridium difficile infection (CDI) and AH. We examined the prevalence and effects of CDI in patients with AH, compared with those of other infections.
  
  
  METHODS
  We performed a cross-sectional analysis using data collected from the Nationwide Inpatient Sample, from 2008 through 2011. International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with AH. We used multivariable logistic regression to determine risk factors that affect mortality, negative binomial regression to evaluate the effects of CDI on predicted length of stay (LOS), and Poisson regression to determine the effects of CDI on predicted hospital charges. Chi-square and Wilcoxon rank-sum analyses were used to compare mortality, LOS, and hospital charges associated with CDI with those associated with urinary tract infection (UTI) and spontaneous bacterial peritonitis (SBP).
  
  
  RESULTS
  Of 10,939 patients with AH, 177 had CDI (1.62%). Patients with AH and CDI had increased odds of inpatient mortality (adjusted odds ratio, 1.75; P = .04), a longer predicted LOS (10.63 vs 5.75 d; P < .001), and greater predicted hospital charges ($36,924.30 vs $29,136.58; P < .001), compared with those without CDI. Compared with UTI, CDI was associated with similar mortality but greater LOS (9 vs 6 d; P < .001) and hospital charges ($45,607 vs $32,087; P < .001). SBP was associated with higher mortality than CDI (17.3% vs 10.1%; P = .045), but similar LOS and hospital charges.
  
  
  CONCLUSIONS
  In patients with AH, CDI is associated with greater mortality and health care use. These effects appear similar to those for UTI and SBP. We propose further studies to determine the cost effectiveness of screening for CDI among patients with AH.
authors.affiliation: Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: vinay.sundaram@cshs.org.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.
authors.forename: Folasade P
authors.initials: FP
authors.lastname: May
authors.affiliation: Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Vignan
authors.initials: V
authors.lastname: Manne
authors.affiliation: Department of Medicine and Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006519:Hepatitis, Alcoholic / Q000150:complications*; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D016019:Survival Analysis; D055815:Young Adult
keywords: Alcoholic Liver Disease; Database; ICD-9-CM; NIS