Effects of Clostridium difficile infection in patients with alcoholic hepatitis

doi:10.1016/j.cgh.2014.02.041

. 2014 Oct;12(10):1745-52.e2.

doi: 10.1016/j.cgh.2014.02.041. Epub 2014 Mar 27.

Effects of Clostridium difficile infection in patients with alcoholic hepatitis

Vinay Sundaram¹, Folasade P May², Vignan Manne³, Sammy Saab⁴

Affiliations

¹ Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: vinay.sundaram@cshs.org.
² Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.
³ Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
⁴ Department of Medicine and Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.

PMID: 24681081
PMCID: PMC4171202
DOI: 10.1016/j.cgh.2014.02.041

Effects of Clostridium difficile infection in patients with alcoholic hepatitis

Vinay Sundaram et al. Clin Gastroenterol Hepatol. 2014 Oct.

. 2014 Oct;12(10):1745-52.e2.

doi: 10.1016/j.cgh.2014.02.041. Epub 2014 Mar 27.

Authors

Vinay Sundaram¹, Folasade P May², Vignan Manne³, Sammy Saab⁴

Affiliations

¹ Division of Gastroenterology and Hepatology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: vinay.sundaram@cshs.org.
² Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California.
³ Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
⁴ Department of Medicine and Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.

PMID: 24681081
PMCID: PMC4171202
DOI: 10.1016/j.cgh.2014.02.041

Abstract

Background & aims: Infection increases mortality in patients with alcoholic hepatitis (AH). Little is known about the association between Clostridium difficile infection (CDI) and AH. We examined the prevalence and effects of CDI in patients with AH, compared with those of other infections.

Methods: We performed a cross-sectional analysis using data collected from the Nationwide Inpatient Sample, from 2008 through 2011. International Classification of Diseases, 9th revision, Clinical Modification codes were used to identify patients with AH. We used multivariable logistic regression to determine risk factors that affect mortality, negative binomial regression to evaluate the effects of CDI on predicted length of stay (LOS), and Poisson regression to determine the effects of CDI on predicted hospital charges. Chi-square and Wilcoxon rank-sum analyses were used to compare mortality, LOS, and hospital charges associated with CDI with those associated with urinary tract infection (UTI) and spontaneous bacterial peritonitis (SBP).

Results: Of 10,939 patients with AH, 177 had CDI (1.62%). Patients with AH and CDI had increased odds of inpatient mortality (adjusted odds ratio, 1.75; P = .04), a longer predicted LOS (10.63 vs 5.75 d; P < .001), and greater predicted hospital charges ($36,924.30 vs $29,136.58; P < .001), compared with those without CDI. Compared with UTI, CDI was associated with similar mortality but greater LOS (9 vs 6 d; P < .001) and hospital charges ($45,607 vs $32,087; P < .001). SBP was associated with higher mortality than CDI (17.3% vs 10.1%; P = .045), but similar LOS and hospital charges.

Conclusions: In patients with AH, CDI is associated with greater mortality and health care use. These effects appear similar to those for UTI and SBP. We propose further studies to determine the cost effectiveness of screening for CDI among patients with AH.

Keywords: Alcoholic Liver Disease; Database; ICD-9-CM; NIS.

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Conflict of interest statement

Disclosures: The authors have no conflicts of interest to disclose

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References

1. Mathurin P, Duchatelle V, Ramond MJ, et al. Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology. 1996;110:1847–53. - PubMed
1. O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010;105:14–32. quiz 33. - PubMed
1. Lafferty H, Stanley AJ, Forrest EH. The management of alcoholic hepatitis: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2013;38:603–10. - PubMed
1. Mathurin P, Mendenhall CL, Carithers RL, Jr, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480–7. - PubMed
1. Sandahl TD, Jepsen P, Thomsen KL, et al. Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: a nationwide population based cohort study. J Hepatol. 2011;54:760–4. - PubMed

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[1] Mathurin P, Duchatelle V, Ramond MJ, et al. Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology. 1996;110:1847–53. - PubMed

[2] Mathurin P, Duchatelle V, Ramond MJ, et al. Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology. 1996;110:1847–53. - PubMed

[3] O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010;105:14–32. quiz 33. - PubMed

[4] O’Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010;105:14–32. quiz 33. - PubMed

[5] Lafferty H, Stanley AJ, Forrest EH. The management of alcoholic hepatitis: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2013;38:603–10. - PubMed

[6] Lafferty H, Stanley AJ, Forrest EH. The management of alcoholic hepatitis: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2013;38:603–10. - PubMed

[7] Mathurin P, Mendenhall CL, Carithers RL, Jr, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480–7. - PubMed

[8] Mathurin P, Mendenhall CL, Carithers RL, Jr, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480–7. - PubMed

[9] Sandahl TD, Jepsen P, Thomsen KL, et al. Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: a nationwide population based cohort study. J Hepatol. 2011;54:760–4. - PubMed

[10] Sandahl TD, Jepsen P, Thomsen KL, et al. Incidence and mortality of alcoholic hepatitis in Denmark 1999–2008: a nationwide population based cohort study. J Hepatol. 2011;54:760–4. - PubMed

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Effects of Clostridium difficile infection in patients with alcoholic hepatitis

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Effects of Clostridium difficile infection in patients with alcoholic hepatitis

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