C0100 - Outcomes of Clostridioides difficile Infection in Hospitalized Patients With Generalized Anxiety Disorder

Shivani J. Patel, MD¹, Alexander J. Kaye, MD, MBA¹, Sarah Meyers, DO², Pooja Saiganesh, BA¹, Sushil Ahlawat, MD^1
1Rutgers New Jersey Medical School, Newark, NJ; ²Rutgers Robert Wood Johnson Medical School, Piscataway, NJ

Introduction: Clostridioides difficile infection (CDI) is a significant burden for healthcare facilities. Clinical presentation can range from mild diarrhea to colitis. Higher levels of anxiety have been reported in patients with recurrent CDI. Generalized anxiety disorder (GAD) is a common form of anxiety. Our study aims to understand the impact of comorbid GAD on the outcomes of hospitalized patients with CDI.

Methods: Hospitalized patients with CDI were selected from the 2014 National Inpatient Sample database based on ICD-9 codes. Patient demographics and outcomes of CDI were compared between groups with and without GAD. The outcomes included respiratory failure, renal failure (AKI), sepsis, megacolon, colonic perforation, hypotension/shock, intestinal abscess, hepatic failure, and inpatient mortality. The proportions and means were compared using chi-squared tests and independent t-tests respectively. After adjusting for age, race, sex, and Charlson Comorbidity Index (CCI), a multivariate logistic regression analysis was used to assess GAD as an independent predictor of the outcomes.

Results: For the year 2014, 72,379 hospitalized adults were diagnosed with CDI. Patients with CDI and comorbid GAD were younger (62.1 vs 65.4 years old, p< 0.001), more likely to be female (72.3% vs 56.3%, p< 0.001), more likely to be white (84% vs 72.6%, p< 0.001), had a lower CCI (3.91 vs 4.57, p< 0.001), had a shorter length of stay (9.55 days vs 10.70 days, p< 0.001), and had a smaller hospital charge ($77,039 vs $96,129, p< 0.001). GAD was noted to be an independent risk factor for inpatient mortality (adjusted odds ratio (aOR) 1.57, 95% confidence interval (CI): 1.40-1.76, p< 0.001), sepsis (aOR 1.26, 95% CI: 1.20-1.34, p< 0.001), hypotension/shock (aOR 1.12, 95% CI: 1.06-1.19, p< 0.001), respiratory failure (aOR 1.23, 95% CI: 1.14-1.33, p< 0.001), AKI (aOR 1.27, 95% CI: 1.20-1.33, p< 0.001), acute hepatic failure (aOR 1.47, 95% CI: 1.15-1.89, p=0.003), and colonic perforation (aOR 1.62, 95% CI: 1.08-2.43, p=0.019). GAD was not a risk factor for intestinal abscess (aOR 0.99, 95% CI: 0.70-1.40, p=0.969). The analysis for megacolon could not be performed due to small sample size.

Discussion: Hospitalized CDI patients with a history of GAD are more likely to have increased mortality, sepsis, multi-organ failure and colon perforation. These findings are likely due to GAD’s association with a pro-inflammatory state, inconsistent healthcare utilization, and altered gut microbiota.


Disclosures:


Shivani J. Patel, MD¹, Alexander J. Kaye, MD, MBA¹, Sarah Meyers, DO², Pooja Saiganesh, BA¹, Sushil Ahlawat, MD¹. C0100 - Outcomes of Clostridioides difficile Infection in Hospitalized Patients With Generalized Anxiety Disorder, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.