Outcomes and risk factors for mortality in clostridioides difficile infection in patients with NAFLD and NASH

Ankoor H Patel; Gaurav N Pathak; Alexander Chen; Patricia Greenberg; Natale Mazzaferro; Anish Patel; Naveen Mallangada; Carlos D Minacapelli; Kaitlyn Catalano; Hansel Suthar; Vinod K Rustgi

doi:10.1016/j.aohep.2024.101510

Outcomes and risk factors for mortality in clostridioides difficile infection in patients with NAFLD and NASH

Ann Hepatol. 2024 May 5:101510. doi: 10.1016/j.aohep.2024.101510. Online ahead of print.

Affiliations

¹ Internal Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ, the United States.
² Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States.
³ Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, the United States.
⁴ Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States; Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States.
⁵ Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States; Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States. Electronic address: vinod.rustgi@rutgers.edu.

PMID: 38714224
DOI: 10.1016/j.aohep.2024.101510

Abstract

Introduction and objectives: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and can progress to non-alcoholic steatohepatitis (NASH) and, ultimately, cirrhosis. Clostridioides difficile is the most common nosocomial cause of diarrhea and is associated with worse clinical outcomes in other liver diseases, including cirrhosis, but has not been extensively evaluated in concomitant NAFLD/NASH.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2017. Patients with a diagnosis of CDI, NAFLD, and NASH were identified using International Classification of Diseases (Tenth Revision) codes. The outcomes of our study include length of stay, hospitalization cost, mortality, and predictors of mortality.

Results: The CDI and NASH cohort had a higher degree of comorbidity burden and prevalence of peptic ulcer disease, congestive heart failure, diabetes mellitus, and cirrhosis. Patients with NASH and CDI had a significantly higher mortality rate compared to the CDI only cohort (mortality, 7.11 % vs 6.36 %; P = 0.042). Patients with CDI and NASH were at increased risk for liver-related complications, acute kidney injury, and septic shock (P < 0.001) compared to patients with CDI only. Older age, intestinal complications, pneumonia, sepsis and septic shock, and liver failure conferred an increased risk of mortality among the CDI and NASH cohort.

Conclusions: Patients with NASH had a higher rate of liver-related complications, progression to septic shock, and mortality rate following CDI infection compared to the CDI only cohort.

Keywords: Clostridioides difficile; Mortality; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis.