C0403 - Clostridium difficile Infection in Inflammatory Bowel Disease, Risk Analysis and Determination of Complications Based on Nationwide Inpatient Sample Database

Yash Shah, MD¹, Pranav D. Patel, MD², Deepa P. Budh, MD³, Sahil Raval, MD⁴, Deep Mehta, MD⁵, Pooja Shah, MBBS, MS⁶, Rutikbhai Desai, MBBS⁷, Dhruvan Patel, MD⁸, Harshit S. Khara, MD, FACG^9
1Hackensack Meridian Ocean Medical Center, Brick, NJ; ²Geisinger Medical Center, Danville, PA; ³St. Barnabas Health System, Bronx, NY; ⁴Saint Peter's University Hospital, New Brunswick, NJ; ⁵St. Francis Medical Center, Trenton, NJ; ⁶Baroda Medical College, Brick, NJ; ⁷GMERS Medical College - Sola, Ahmedabad, Jersey City, NJ; ⁸Mercey Fitzgerald Hospital, Darby, PA; ⁹Geisinger Health System, Danville, PA

Introduction: Inflammatory bowel disease (IBD) mainly consists of Ulcerative colitis (UC) and Crohn’s Disease (CD) affects over 3 million US adults. IBD patients tend to have a higher risk of infection due to inflammation, altered mucosal barrier, and immunosuppressive medications. Clostridium difficile infection (CDI) is one of the most common infections associated with IBD. Our aim was to assess the outcomes of inpatient admissions of IBD who have concurrent CDI.

Methods: We utilized the Nationwide Inpatient Sample (NIS) database from 2018 and 2019. Adult hospitalizations due to IBD with and without CDI were identified by previously validated ICD-10-CM codes. We used propensity score matching to balance the difference in baseline characteristics and comorbidities. Univariate and multivariate logistic regression for categorical variables and linear regression for continuous variables was carried out to identify independent associations at p < 0.05. Statistical Analysis was performed using R studio.

Results: A total of 102,920 patients were included in the study with IBD-related hospitalization. 25,730 patients with IBD had CDI of which 14,995 (58%) were females. IBD patients with CDI had an increased crude mortality rate of 3.3% vs 1.4% in IBD patients without CDI (p < 0.001) (Table 1). A higher proportion of IBD patients with CDI were on immunosuppressive medications 8.4% vs 6.7% (p< 0.01) in IBD patients without CDI. IBD patients with CDI have significantly higher rates of acute kidney injury, cardiovascular shock, and acute respiratory failure requiring mechanical ventilation. On multivariate analysis, IBD patients with CDI had 2 fold greater risk of death (OR 2.32, 95% CI: 1.89–2.84); more than 2 fold greater risk of a shock (OR 2.7, 95% CI: 2.36–3.08); higher risk of requiring ICU level of care (Table 2). Total adjusted charges are higher in IBD with CDI ($44,413) compared to without CDI ($32,224). The median length of stay is higher in IBD patients with CDI (5 days) compared to those without CDI (3 days) (Table-1).

Discussion: IBD patients with CDI have a higher crude mortality rate, end-organ damage leading to severe CDI, and increased healthcare resource utilization. Early diagnosis of CDI, judicious use of antibiotics, and immunosuppressive medications should be recommended in IBD patients. IBD patients on immunosuppressive medications have a higher risk of CDI. Further research is needed for the reduction of morbidity and mortality in IBD patients with CDI.



Disclosures:


Yash Shah, MD¹, Pranav D. Patel, MD², Deepa P. Budh, MD³, Sahil Raval, MD⁴, Deep Mehta, MD⁵, Pooja Shah, MBBS, MS⁶, Rutikbhai Desai, MBBS⁷, Dhruvan Patel, MD⁸, Harshit S. Khara, MD, FACG⁹. C0403 - Clostridium difficile Infection in Inflammatory Bowel Disease, Risk Analysis and Determination of Complications Based on Nationwide Inpatient Sample Database, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.