Clostridium difficile Infection in Liver Cirrhosis Carries a Higher Risk of Mortality: A Comprehensive Literature Review

Aravamudan, Veeraraghavan Meyyur; Khan, Shahab R.; Hussain, Ikram

doi:10.7759/cureus.5463

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…First, this population of patients is getting sicker over time: even compared with 2012, patients with CLDs admitted in 2016 were older, more likely to have cirrhosis and cirrhosis-related complications, and have more comorbidities (including coronary artery disease, congestive heart failure, chronic kidney disease, and diabetes) (18). The costs of managing a more complex patient population are expected to be high because these patients are at risk for both disease-related and iatrogenic complications, such as renal decompensation, Clostridium difficile infection, and gastrointestinal bleeding (6,19). Second, we demonstrated that the increased intensity and price of inpatient care was the primary driver of increased healthcare spending in patients with CLDs or cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Economic Burden of Chronic Liver Diseases and Cirrhosis in the United States: 1996–2016

Qian

Nguyen

et al. 2021

Am J Gastroenterol

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INTRODUCTION: The management of chronic liver diseases (CLDs) and cirrhosis is associated with substantial healthcare costs. We aimed to estimate trends in national healthcare spending for patients with CLDs or cirrhosis between 1996 and 2016 in the United States. METHODS: National-level healthcare expenditure data developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project and prevalence of CLDs and cirrhosis derived from the Global Burden of Diseases Study were used to estimate temporal trends in inflation-adjusted US healthcare spending, stratified by setting of care (ambulatory, inpatient, emergency department, and nursing care). Joinpoint regression was used to evaluate temporal trends, expressed as annual percent change (APC) with 95% confidence intervals (CIs). Drivers of change in spending for ambulatory and inpatient services were also evaluated. RESULTS: Total expenditures in 2016 were $32.5 billion (95% CI, $27.0–$40.4 billion). Over 65% of spending was for inpatient or emergency department care. From 1996 to 2016, there was a 4.3%/year (95% CI, 2.8%–5.8%) increase in overall healthcare spending for patients with CLDs or cirrhosis, driven by a 17.8%/year (95% CI, 14.5%–21.6%) increase in price and intensity of hospital-based services. Total healthcare spending per patient with CLDs or cirrhosis began decreasing after 2008 (APC −1.7% [95% CI, −2.1% to −1.2%]), primarily because of reductions in ambulatory care spending (APC −9.1% [95% CI, −10.7% to −7.5%] after 2011). DISCUSSION: Healthcare expenditures for CLDs or cirrhosis are substantial in the United States, driven disproportionately by acute care in-hospital spending.

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Section: Discussionmentioning

confidence: 99%

Trends in the Economic Burden of Chronic Liver Diseases and Cirrhosis in the United States: 1996–2016

Qian

Nguyen

et al. 2021

Am J Gastroenterol

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“…These hemodynamic changes also undermine patient hospital outcomes, expediting hospital death in this cohort of patients with alcoholic hepatitis 66. Furthermore, it is also possible the bowel edema that is caused by the intestinal venous congestion from elevated portal pressures disrupt the bowel flora, induce intestinal slow-down, promote bacterial translocation, and overall set the intestinal environment prone to bacterial infections,67–69 including C. difficile as observed in this study. However, further prospective studies are needed for this mechanism to be clearly observed in physiological settings.…”

Section: Discussionmentioning

confidence: 72%

The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis

Lee

Fan

Hastie

et al. 2021

Journal of Clinical Gastroenterology

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Goals: We specifically evaluate the effect of malnutrition on the infection risks of patients admitted with alcoholic hepatitis using a national registry of hospitalized patients in the United States. Background: Malnutrition is a common manifestation of alcoholic hepatitis that affects patient outcomes. Study: 2011 to 2017 National Inpatient Sample was used to isolated patients with alcoholic hepatitis, stratified using malnutrition (protein-calorie malnutrition, sarcopenia, and weight loss/cachexia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. Endpoints included mortality and infectious endpoints. Results: After matching, there were 10,520 with malnutrition and 10,520 malnutrition-absent controls. Mortality was higher in the malnutrition cohort [5.02 vs. 2.29%, P<0.001, odds ratio (OR): 2.25, 95% confidence interval (CI): 1.93-2.63], as were sepsis (14.2 vs. 5.46, P<0.001, OR: 2.87, 95% CI: 2.60-3.18), pneumonia (10.9 vs. 4.63%, P<0.001, OR: 2.51, 95% CI: 2.25-2.81), urinary tract infection (14.8 vs. 9.01%, P<0.001, OR: 1.76, 95% CI: 1.61-1.91), cellulitis (3.17 vs. 2.18%, P<0.001, OR: 1.47, 95% CI: 1.24-1.74), cholangitis (0.52 vs. 0.20%, P<0.001, OR: 2.63, 95% CI: 1.59-4.35), and Clostridium difficile infection (1.67 vs. 0.91%, P<0.001, OR: 1.85, 95% CI: 1.44-2.37). In multivariate models, malnutrition was associated with mortality [P<0.001, adjusted odds ratio (aOR): 1.61, 95% CI: 1.37-1.90] and infectious endpoints: sepsis (P<0.001, aOR: 2.42, 95% CI: 2.18-2.69), pneumonia (P<0.001, aOR: 2.19, 95% CI: 1.96-2.46), urinary tract infection (P<0.001, aOR: 1.68, 95% CI: 1.53-1.84), cellulitis (P<0.001, aOR: 1.46, 95% CI: 1.22-1.74), cholangitis (P=0.002, aOR: 2.27, 95% CI: 1.36-3.80), and C. difficile infection (P<0.001, aOR: 1.89, 95% CI: 1.46-2.44). Conclusion: This study shows the presence of malnutrition is an independent risk factor of mortality and local/systemic infections in patients admitted with alcoholic hepatitis.

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Predicting Microbe-Disease Association Based on Multiple Similarities and LINE Algorithm

Wang

Lei

et al. 2022

IEEE/ACM Trans. Comput. Biol. and Bioinf.

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Clostridium difficile Infection in Liver Cirrhosis Carries a Higher Risk of Mortality: A Comprehensive Literature Review

Cited by 3 publications

References 14 publications

Trends in the Economic Burden of Chronic Liver Diseases and Cirrhosis in the United States: 1996–2016

Trends in the Economic Burden of Chronic Liver Diseases and Cirrhosis in the United States: 1996–2016

The Impact of Malnutrition on the Hospital and Infectious Outcomes of Patients Admitted With Alcoholic Hepatitis

Predicting Microbe-Disease Association Based on Multiple Similarities and LINE Algorithm

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