Effects of Clostridium difficile Infection in Patients with Alcoholic Hepatitis.
Clin Gastroenterol Hepatol. 2014 Mar 26;
Authors: Sundaram V, May FP, Manne V, Saab S
BACKGROUND: & Aims: 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 patientswith 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, Ninth 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. χ(2) and Wilcoxon rank-sum analyses were used to compare mortality, LOS, and hospital charges associated with CDI to 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), longer predicted LOS (10.63 days vs 5.75 days, P<.001) and greater predicted hospital charges ($36,924.30 vs $29,136.58, P<.001), compared to those without CDI. Compared to UTI, CDI was associated with similar mortality but greater LOS (9 vs 6 days, 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=0.045), but similar LOS and hospital charges.
CONCLUSIONS: In patients with AH, CDI is associated with greater mortality and healthcare utilization. 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.
PMID: 24681081 [PubMed - as supplied by publisher]