Predictors of Mortality in Cirrhosis Inpatients With Clostridium difficile Infection

Smith, Elliot; Northup, Patrick G.; Argo, Curtis K.

doi:10.1097/mcg.0000000000000868

Cited by 21 publications

(25 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could possibly be related to generalized suppression of defense mechanism associated with liver failure, effects of hypoalbuminemia and increased risk of bacterial translocation resulting in spontaneous bacterial peritonitis in patients with chronic liver disease. Smith et al [14] reported prolonged LOS in patients with liver cirrhosis and CDI when compared to patients without CDI (15.1 days vs. 6.55 days). Bajaj et al [10] noted that LOS was as twice as long in patients with cirrhosis and CDI, compared to patients without CDI (14.4 days vs. 6.7 days).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Clostridioides difficile Infection in Patients With Liver Cirrhosis: A Nationwide Study

et al. 2020

View full text Add to dashboard Cite

Background: Clostridioides difficile infection (CDI) is a major health problem that has been on the rise for the last couple of decades. It has significant mortality and morbidity in hospitalized patients. We looked at the outcomes of CDI in patients with liver cirrhosis compared to those without liver cirrhosis. Methods:We conducted a retrospective study from a large inpatient database. The National Inpatient Sample (NIS) was queried for CDI admissions between January 2012 and September 2015. Patients admitted with CDI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The outcomes included overall mortality, length of hospitalization, and healthcare expenditure related to hospitalization. Results:Out of all patients, 53,765 (3.97%) had concurrent CDI and liver cirrhosis. Diabetes mellitus, alcohol abuse, and acquired immunodeficiency were observed more in patients with liver cirrhosis. Overall mortality (adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.53 -1.77, P < 0.001), cost of hospitalization and length of hospital stay (11.0 vs. 10.4 days, P < 0.001) were significantly higher in patients with cirrhosis. Conclusions:Patients with CDI and liver cirrhosis have significantly higher mortality, prolonged hospitalization and healthcare expenditure. Further studies are recommended to look at reversible risk factors for CDI in patients with liver cirrhosis to guide quality measures that would ultimately improve outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Clostridioides difficile Infection in Patients With Liver Cirrhosis: A Nationwide Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…An early meta-analysis published in 2015 showed that PPI use was not associated with increased mortality in patients with cirrhosis [11]. However, only four cohort studies [14,16,17,19] were included in the present study, and many related cohort studies have been published since the previous meta-analysis [18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. In addition, it remains unknown…”

Section: Introductionmentioning

confidence: 89%

“…Overall, 21 cohort studies with 20,899 patients and 7457 death events were included, of which 16 were retrospective cohort studies [16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33], while the other five were prospective cohort [14,15,20,21,34]. As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18]…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

“…As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18][20][21][22][23][24][28][29][30]32,34], while six studies included cirrhotic patients with SBP [19,26], HE [25], Clostridium difficile infection [27], pneumonia [31], and after transjugular intrahepatic portosystemic shunt [33], respectively. The mean ages of the patients varied from 53 to 63 years, and the proportions of male patients varied from 53% to 77%.…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Proton pump inhibitor use and mortality in patients with cirrhosis: a meta-analysis of cohort studies

Wu¹,

Zhang

Yu³

et al. 2020

Bioscience Reports

View full text Add to dashboard Cite

Background: Proton pump inhibitor (PPI) is commonly used in patients with cirrhosis. However, some studies demonstrated that PPI use was associated with adverse outcome in patients with cirrhosis. We aimed to perform a meta-analysis of cohort studies to evaluate the association between PPI use and mortality in cirrhotic patients. Methods: Relevant studies were obtained via search of PubMed and Embase databases. A randomized-effect model was used to pool the results. Subgroup analyses were performed to evaluate the source of heterogeneity. Results: Overall, 21 cohort studies with 20,899 patients and 7457 death events were included. The pooled results with a randomized-effect model showed that PPI use was associated with significantly increased risk of mortality in patients with cirrhosis (adjusted relative risk [RR] = RR: 1.39, P<0.001) with considerable heterogeneity (I2=73%). Subgroup analyses showed that characteristics such as patient ethnicity, sample size, definition of PPI use, and complications of patients did not affect the association. However, the association between PPI use and mortality was independent of study characteristics including patient ethnicity, sample size, complications, definition of PPI use, and follow-up duration. However, the association between PPI use and mortality in cirrhotic patients was significant in retrospective studies (RR: 1.40, P<0.001), but not in prospective studies (RR: 1.34, P=0.33). Conclusions: PPI use may be associated with moderately increased mortality in cirrhotic patients. Although prospective cohort studies are needed to validate our findings, PPI should only prescribed to cirrhotic patients with indications for the treatment.

show abstract

“…Northup, Argo [6] Predictors of mortality in cirrhosis inpatients with Clostridium difficile infection.…”

Section: Smithmentioning

confidence: 99%

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

Aravamudan

Khan

Hussain

2019

Cureus

View full text Add to dashboard Cite

Clostridium difficile (C. difficile) infection is associated with higher mortality in liver cirrhosis. This literature review discusses the risk factors associated with increased mortality in patients with C. difficile infection in liver cirrhosis. This literature review also highlights the importance of selecting antibiotics wisely, carefully selecting patients who are candidates for antibiotic prophylaxis for spontaneous bacterial peritonitis in liver cirrhosis and avoiding unnecessary proton pump inhibitors in liver cirrhosis.

show abstract

Predictors of Mortality in Cirrhosis Inpatients With Clostridium difficile Infection

Cited by 21 publications

References 34 publications

Outcomes of Clostridioides difficile Infection in Patients With Liver Cirrhosis: A Nationwide Study

Outcomes of Clostridioides difficile Infection in Patients With Liver Cirrhosis: A Nationwide Study

Proton pump inhibitor use and mortality in patients with cirrhosis: a meta-analysis of cohort studies

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

Contact Info

Product

Resources

About