P1772 - Healthcare Burden and Impact of Clostridioides difficile Infection Among Liver Cirrhosis Hospitalizations in the United States From 2003 to 2017

Harika Kandlakunta, MD¹, Liliane Deeb, MD^2
1Staten Island University Hospital, Northwell Health, Staten Island, NY; ²Staten Island University Hospital, Staten Island, NY

Introduction: Clostridioides Difficile infection (CDI) is common in patients with cirrhosis and associated with poor outcomes. There is a paucity of contemporary large-scale data to evaluate the impact of CDI on mortality and resource utilization in hospitalized cirrhotic patients.

Methods: Using the National Inpatient Sample database from January 2003 through December 2017, we identified all hospitalizations with primary or secondary diagnosis of liver cirrhosis, and a concomitant diagnosis of CDI. We compared characteristics, in-hospital mortality, and resource utilization between cirrhosis hospitalizations with and without CDI. Hierarchical logistic regression analysis was used to evaluate adjusted in-hospital mortality accounting for patient demographics, hospital characteristics and comorbid conditions.

Results: There were a total of 7,821,319 hospitalizations with a primary or secondary diagnosis of liver cirrhosis. Among these, a concomitant diagnosis of CDI was seen in 151,152 (1.9%). Over the 15 year study period, prevalence of CDI among cirrhosis hospitalizations increased from 1.0% in 2003 to 2.2% in 2017 (Ptrend< 0.001). Hospitalizations with cirrhosis and CDI were significantly noted in older patients (60.6 ± 13.3 vs 58.8 ± 12.8 years), more often females (44.6% vs 39.1%), and were associated with higher rates of comorbid conditions (all P< 0.001) compared to those without CDI. Those with cirrhosis and CDI had higher unadjusted and adjusted in-hospital mortality (10.8% vs 6.5%; OR 1.68 [95% CI 1.65-1.71]; P< 0.001) compared to those without CDI. Hospitalized cirrhotic patients with CDI had significantly longer hospital stays (median interquartile range:[IQR]; 8[4-15] vs 4[2-7] days, P< 0.001), higher hospitalization charges (median [IQR]; $49,264[24,805-107,737] vs $27,214[14,430-53,467]; P< 0.001), less frequent routine home discharges (38.3% vs 58.0%) and higher rates of dismissal to skilled nursing facilities (29.7% vs 16.4%) compared to those without CDI (P< 0.001).

Discussion: There is a steady increase in the prevalence of C Difficile infections among hospitalized cirrhotic patients. Presence of C. Difficile infection is associated with a significantly higher in-hospital mortality and increased healthcare burden evidenced by longer hospital stays and higher hospitalization charges. Judicious use of antibiotics and proton pump inhibitors as well as other effective measures to prevent C Difficile infection in this special population is of utmost importance to avoid those poor outcomes.

Characteristic	Cirrhosis with C. Difficile infection (N=151,152)	Cirrhosis without C. Difficile infection (N= 7,670,167)	P
Age (years)	60.6 ± 13.3	58.8 ± 12.8	< 0.001
Female sex	44.6%	39.1%	< 0.001
Race
White	69.6%	65.5%	< 0.001
Black	11.2%	10.8%	< 0.001
Hispanic	13.6%	17.4%	< 0.001
Others*	5.6%	6.3%	< 0.001
Primary payer
Medicare	50.0%	44.4%	< 0.001
Medicaid	21.7%	22.9%	< 0.001
Private	20.5%	21.2%	< 0.001
Others**	7.9%	11.4%	< 0.001
Median household income quartile
0-25th	30.2%	34.0%	< 0.001
26th-50th	25.2%	26.3%	< 0.001
51st-75th	24.0%	22.6%	< 0.001
75th-100th	20.7%	17.0%	< 0.001
Hospital teaching status and location
Rural	6.0%	9.0%	< 0.001
Urban non-teaching	30.9%	35.0%	< 0.001
Urban teaching	63.1%	55.9%	< 0.001
Hospital bed-size
Small	12.0%	12.8%	< 0.001
Medium	24.7%	25.8%	< 0.001
Large	63.3%	61.4%	< 0.001
Hospital region
Northeast	20.8%	18.3%	0.4
Midwest	22.0%	18.9%	0.4
South	33.9%	39.4%	0.4
West	23.4%	23.4%	0.4
Congestive heart failure	17.2%	11.8%	< 0.001
Hypertension	47.8%	45.0%	< 0.001
Diabetes without complications	21.9%	24.1%	< 0.001
Diabetes with complications	11.0%	8.3%	< 0.001
Chronic lung disease	22.0%	19.3%	< 0.001
Renal failure	24.6%	16.4%	< 0.001
Obesity	9.1%	9.4%	< 0.001

Table: Table 1. Baseline characteristics of cirrhosis hospitalizations with and without Clostridoides infection
*Asian or Pacific Islander, Native American, Others; **Self-Pay, No Charge, Others


Disclosures:
Harika Kandlakunta indicated no relevant financial relationships.
Liliane Deeb indicated no relevant financial relationships.


Harika Kandlakunta, MD¹, Liliane Deeb, MD². P1772 - Healthcare Burden and Impact of Clostridioides difficile Infection Among Liver Cirrhosis Hospitalizations in the United States From 2003 to 2017, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.