Outcomes of Clostridioides difficile in Patients with Vitamin D Deficiency: A Propensity-Matched National Inpatient Sample Analysis. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Gayam, Vijay; Mandal, Amrendra Kumar; Ditah, Chobufo Muchi; Sidhu, Jasdeep; Konala, Venu Madhav; Adapa, Sreedhar; Naramala, Srikanth; Garlapati, Pavani
• Is Part Of: Southern medical journal. Volume 113:Issue 11(2020)
• Publication Date: 2020-11
• Subjects: Clostridioides difficile infection -- morbidity -- mortality -- vitamin D; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001168
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: We aimed to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of Clostridioides difficile infection (CDI) and vitamin D deficiency (VDD). Methods: The National Inpatient Sample database for 2016 and 2017 was used for data analysis using International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System ( ICD-10-CM/PCS ) codes to identify the patients with the principal diagnosis of CDI and VDD. We assessed the all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of CDI without VDD versus CDI with VDD. Results: We identified 202, 234 patients with CDI, 4515 of whom were patients with VDD and 197, 719 of whom were without VDD. After propensity matching, there was no difference in the in-hospital mortality between the two groups (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.58–4.3; P = 0.90). CDI with VDD has a higher odds of sepsis (OR 1.6, 95% CI 1.3–1.9; P = 0.0), and peritonitis (OR 1.6, 95% CI 1.4–3.8; P = 0.01). Mean LOS (5.9 ± 1.8 vs 5.4 ± 2, P < 0.01) and mean total charges ($11, 500 vs $9971, P < 0.04) were higher in CDI with VDD. The factors affecting the LOS were acute coronary syndrome ( P = 0.04), mechanical ventilation ( P = 0.03), obesity ( P = 0.004), acute kidney injury ( P = 0.04), and sepsis ( P = 0.05). Conclusions: In this large cohort in a propensity-matched analysis, VDD does not increase the in-hospital mortality in CDI. VDD increases the odds of complications with a higher LOS and resource utilization. These findings may be clinically relevant to guide clinicians to routinely monitor vitamin D status and supplement in patients at risk of CDI. Abstract : Clostridioides difficile infection (CDI) has emerged as a common healthcare-associated infection with significant morbidity. It is estimated that CDI is responsible for at least 500, 000 cases of infection in the United States annually. Recent studies have emphasized the immunological role of vitamin D in intestinal inflammation and in determining susceptibility to infection. Only a few studies have analyzed an association between vitamin D levels and the outcomes of patients with CDI. Because there is a heavy burden imposed on health systems by CDI and the current contrasting evidence around vitamin D deficiency and CDI, the authors aimed to analyze whether vitamin D deficiency is associated with the increased mortality and mortality in patients presenting with CDI.