A0099 - The Impact of Malnutrition on Patients Hospitalized With Clostridioides difficile Infection

Introduction: Clostridioides difficile infection (CDI) is the most common healthcare-related diarrhea and is associated with substantial morbidity and mortality. Malnutrition is common amongst patients with CDI, and some studies have suggested that it may increase CDI risk due to secondary immunodeficiency. However, the direct impact of malnutrition on patients who develop CDI has yet to be determined. In this study, we evaluated in-hospital outcomes of malnourished patients admitted to the hospital with CDI.

Methods: A retrospective study was conducted using the Nationwide Inpatient Sample from 2016 to 2019. Adult hospitalizations that had an admitting diagnosis of CDI were identified and stratified based on the presence of malnutrition using the International Classification of Diseases (ICD-10) codes. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) admissions, acute kidney injury (AKI) requiring dialysis, the length of stay (LOS), and hospital charges. Multivariate regression analysis was used to adjust for confounding factors of outcomes.

Results: A total of 1,267,805 patients were admitted to the hospital with CDI during the study period. Of those, 15.17% had a documented diagnosis of malnutrition. Patients with malnutrition had higher mortality, ICU admissions, AKI requiring dialysis, mean LOS, and hospital charges than those without malnutrition. On multivariate analysis, malnutrition was an independent predictor of worse outcomes in patients with CDI. The adjusted odds ratio was 1.77 for mortality (P < 0.001), 1.69 for ICU admission (P < 0.001), and 1.65 for AKI requiring dialysis (P < 0.001). The adjusted mean for LOS and total hospital charges increased by 5.48 days and $64,150 for CDI patients with malnutrition compared to those without malnutrition.

Discussion: Our results highlight the impact of malnutrition on patients admitted to the hospital with CDI. The increased in-hospital mortality and complications underline the importance of identifying malnourished patients as a higher-risk group and suggests that nutritional replenishment may be one strategy to decrease adverse outcomes in patients with or at increased risk of CDI.