Acute Kidney Injury Impact on Inpatient Mortality in Clostridium Difficile Infection-a national propensity-matched study.
J Gastroenterol Hepatol. 2017 Dec 04;:
Authors: Charilaou P, Devani K, John F, Kanna S, Ahlawat S, Young M, Khanna S, Reddy C
OBJECTIVE: Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large-scale, population-based, propensity-matched studies evaluating AKI's effect in this patient cohort.
METHODS: A retrospective observational study utilizing the National Inpatient Sample (NIS) from years 2003-2012, including all adults with CDI, excluding cases missing data on age, inpatient mortality or gender. Trends and CDI-related complications as mortality predictors were assessed using survey-weighted multivariable regression. We estimated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustment.
RESULTS: A total of 2,859,599 patients with CDI were included, of which 896,122 (31.3%) had principal diagnosis of CDI. AKI prevalence was 22%. Mortality rate was 8.4%, while among AKI patients was higher (18.2%). In multivariable regression, AKI was associated with higher mortality (OR=3.16, 95%CI: 3.02-3.30;p<0.001), while after propensity-matching, AKI increased mortality by 86% (OR=1.86, 95%CI: 1.79-1.94;p<0.001). CDI incidence increased by 1.8, together with the rate of AKI (12.6% in 2003 to 28.8% in 2012; p-trend<0.001). Despite increasing hospitalizations, mortality over the study period decreased to 7.2% (2012) from 9.0% (2003); p-trend<0.001.
CONCLUSION: Hospital admissions of patients with CDI and concomitant AKI are increasing, but their inpatient mortality has improved over the study period. AKI is a significant contributor to mortality, independently of other comorbidities, complications, and hospital characteristics, emphasizing the need for early diagnosis and aggressive management in such patients.
PMID: 29205514 [PubMed - as supplied by publisher]