Hackensack University Medical Center Hackensack, NJ, United States
Sophia H. Dar, MD, Mehek Rahim, MD Hackensack University Medical Center, Hackensack, NJ
Introduction: Clostridium difficile infection (CDI) is the leading cause of health-care associated infections, accounting for significant disease burden and mortality. Due to their immunocompromised status and antimicrobial resistance, hematopoietic stem cell transplant (HSCT) recipients are highly vulnerable to development of CDI.
Methods: A retrospective review of the healthcare cost and utilization project: national inpatient sample was conducted for the years 2008-2018. Patient and institutional characteristics were extracted for the analysis. International classification of disease (ICD) codes identified variables including CDI and other comorbidities. Chi-square test was used to assess statistical significance between groups. Multivariate logistic regression was used to analyze independent predictors of mortality, total hospital charges, length of stay and to predict the odds of developing complications including graft vs host disease (GVHD). Total hospital charges were adjusted for inflation using the consumer price index.
Results: A total of 144,253 HSCT recipients were included in this study of which, 33,470 were diagnosed with Clostridium Difficile Colitis (CDC). Patients with CDC had higher odds of mortality (1.70 p< 0.05) compared to those without. The mortality rate fluctuated with 9.2% in 2009 and 4.8% in 2017 (p< 0.05). HSCT recipients with CDC had higher rates of sepsis, acute kidney injury, cardiac arrest, stroke, hypoalbuminemia, malnutrition, atrial fibrillation, and GVHD. CDC increased the odds of developing GVHD (1.30 p< 0.05) and GVHD increased the odds of developing CDC (1.20 p< 0.05). HSCT with CDC who develop GVHD have significantly increased odds of mortality (2.33 p< 0.05).
Discussion: CDC remains a major contributor for morbidity and mortality in HSCT recipients. Our study is the largest to date to evaluate trends and predictors of mortality in this population. We illustrate how CDC increases the incidence of several complications which in turn increases the odds of mortality. GVHD has a bidirectional relationship with CDC. One explanation for this phenomenon is the dysbiosis of the gut microbiota and subsequent inflammation that in turn leaves these patients vulnerable to infection and immune dysregulation.This shared mechanism likely explains how GVHD and CDC significantly increase mortality in HSCT recipients. Further studies are recommended to evaluate prophylactic strategies to decrease CDC as this may decrease the burden of morbidity and mortality in this population.
Figure: Figure 1A is a bar chart reflecting the rates of inpatient complications in HSCT recipients with Clostridium Difficile Colitis Figure 1b is a forrest plot reflecting the predictors of mortality in HSCT recipients with Clostridium Difficile Colitis
Sophia Dar indicated no relevant financial relationships.
Mehek Rahim indicated no relevant financial relationships.
Sophia H. Dar, MD, Mehek Rahim, MD. P2237 - Predictors and Temporal Trends of Mortality in Hematopoietic Stem Cell Transplant Patients With Clostridium difficile Colitis: A Nationwide Analysis Over a Decade, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.