P1171 - 30-Day Readmissions in Clostridium Infections in Patients with Chronic Kidney Disease: A Large Database Retrospective Analysis

Abdullah Sohail, MD¹, Ahmad Khan, MD², Mujtaba Bhinder, MD², Khadija Naseem, MD², Adnan Malik, MD³, Shailendra Singh, MD^4
1West Virginia University Charleston Division, Charleston, WV; ²West Virginia University, Charleston Division, Charleston, WV; ³Loyola University Medical Center, Maywood, IL; ⁴West Virginia University Health Sciences Center, Morgantown, WV

Introduction: Clostridium difficile infection (CDI) is a common cause of transmissible nosocomial infectious diarrhea, leading to frequent rehospitalization. It is usually associated with immunosuppression, prolonged antibiotic course, gastric suppression, and prolonged hospitalizations. Patients with chronic kidney disease (CKD) are at higher risk for many of these known risk factors for CDI. There is limited literature about CDI in patients with concurrent chronic kidney disease. We aimed to investigate the national estimate of 30 -day readmission rate for CDI in patients with CKD and its burden on healthcare expenditures using a large readmission database.

Methods: We queried the national readmission database (NRD) 2017 to identify all the patients hospitalized with clostridium difficile infection (CDI) in patients with concomitant chronic kidney disease using the ICD-10 CM codes. We included all the patients age ≥ 18 years old who had non-elective admissions from January 1st to November 30th for 2017. The primary outcome was all-cause 30-day readmission rates of CDI in CKD patients identifying the most common principal diagnosis for readmission. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges for index and readmissions.

Results: A total of 20,202 adult patients with principal diagnosis CDI with concurrent CKD were identified in the NRD 2017 database. Mean age was calculated as 66.26 years, 56.37 % of them were females and had Medicare(84.85%) as the most common insurance. Baseline patients and hospital characteristics for index and 30-day readmission are given in table 1. A total of 19,709 (97.55%) patients survived to discharge from the index admission. The 30-day all-cause readmission rate was calculated at 26.98% (n=5317). The most common principal diagnosis for readmissions was "Enterocolitis due to Clostridium difficile" (17.19%), followed by"Sepsis” (10.58%) and “unspecified Chronic Kidney Disease” (4.02%). The all-cause inpatient mortality(6.88%) was high during the rehospitalization compared to (2.49%) in the index hospitalization.

Discussion: Our study shows that one out of four patients with CDI with pre-existing CKD are readmitted within 30 days which is associated with higher mortality. These patients may require aggressive treatment and a proper discharge follow-up.


Figure: Figure: Kaplan-Meier curve for 30-day all-cause readmission

Patient Characteristics	Index Admissions	30-day readmissions	P-value
No. of patients	20202	5317
Female (%)	56.37%	55.79 %	p = 0.00
Mean age, (SD)	66.26 yrs	71.58 yrs
Charlson Comorbidity Index Score			P= 0.006
2	0%	04.2 %
3 or more	1%	93.17%
Median Income ( Zip Codes)			p = 0.0848
$1-$38,999	29.61%	31.19%
$39,000-$47,999	29.03 %	29.24 %
$48,000-$62,999	23.94 %	23.35 %
>$ 63,000	17.42%	16.22 %
Insurance Provider			p = 0.073
Medicare	84.85%	83.86 %
Medicaid	5.64 %	6.94 %
Private	8.8%	8.4 %
Hospital Characteristics
Hospital teaching Status			p = 0.8144
Non-Teaching	21.72%	20.86%
Teaching	78.28%	79.14 %
Hospital Bed Size [n, %]			p = 0.4235
Small	18.38%	17.82%
Medium	27.24 %	25.64 %
Large	54.38%	56.54%
Outcomes
Mortality,no.%	492 (2.49%)	366 {6.88%)	p< 0.01
Length of Stay (Mean)	6.4 days	6.7 days	p< 0.01
Total charges (Mean)	$ 45,911	$ 58,586	p< 0.01

Table: Demographics Table


Disclosures:
Abdullah Sohail indicated no relevant financial relationships.
Ahmad Khan indicated no relevant financial relationships.
Mujtaba Bhinder indicated no relevant financial relationships.
Khadija Naseem indicated no relevant financial relationships.
Adnan Malik indicated no relevant financial relationships.
Shailendra Singh indicated no relevant financial relationships.


Abdullah Sohail, MD¹, Ahmad Khan, MD², Mujtaba Bhinder, MD², Khadija Naseem, MD², Adnan Malik, MD³, Shailendra Singh, MD⁴. P1171 - 30-Day Readmissions in Clostridium Infections in Patients with Chronic Kidney Disease: A Large Database Retrospective Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.