Clostridium difficile co-infection in inflammatory bowel disease is associated with significantly increased in-hospital mortality. Issue 9 (September 2018)

• Record Type: Journal Article
• Authors: Rezapour, Mona; Galoosian, Artin; Liu, Benny; Bhuket, Taft; Wong, Robert J.
• Is Part Of: European journal of gastroenterology & hepatology. Volume 30:Issue 9(2018:Sep.)
• Publication Date: 2018-09
• Subjects: Clostridium difficile -- Crohn's disease -- hospitalization -- in-hospital mortality -- ulcerative colitis; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001185
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objective: Inflammatory bowel disease (IBD) patients with Clostridium difficile co-infection (CDCI) have an increased risk of morbidity and mortality. We aim to evaluate the impact of CDCI on in-hospital outcomes among adults with IBD hospitalized in the USA. Patients and methods: Using the 2007–2013 Nationwide Inpatient Sample, hospitalizations among US adults with Crohn's disease (CD), ulcerative colitis (UC) and CDCI were identified using ICD-9 coding. Hospital charges, hospital length of stay (LOS), and in-hospital mortality was stratified by CD and UC and compared using χ 2 -testing and Student's t -test. Predictors of hospital charges, LOS, and in-hospital mortality were evaluated with multivariate regression models and were adjusted for age, sex, race/ethnicity, year, insurance status, hospital characteristics, and CDCI. Results: Among 224 500 IBD hospitalizations (174 629 CD and 49 871 UC), overall prevalence of CDCI was 1.22% in CD and 3.41% in UC. On multivariate linear regression, CDCI was associated with longer LOS among CD [coefficient: 5.30, 95% confidence interval (CI): 4.61–5.99, P <0.001] and UC (coefficient 4.08, 95% CI: 3.54–4.62, P <0.001). Higher hospital charges associated with CDCI were seen among CD (coefficient: $35 720, 95% CI: $30 041–$41 399, P <0.001) and UC (coefficient: $26 009, 95% CI: $20 970–$31 046, P <0.001). On multivariate logistic regression, CDCI was associated with greater risk of in-hospital mortality (CD: odds ratio: 2.74, 95% CI: 1.94–3.87, P <0.001; UC: OR: 5.50, 95% CI: 3.83–7.89, P <0.001). Conclusion: Among US adults with CD and UC related hospitalizations, CDCI is associated with significantly greater in-hospital mortality and greater healthcare utilization.