P1170 - 30-Day Readmissions in Clostridium difficile Infections in Patients With Human Immunodeficiency Virus (HIV): A Large Database Retrospective Analysis

Abdullah Sohail, MD¹, Ahmad Khan, MD², Khadija Naseem, MD², Mujtaba Bhinder, MD², Adil Memon, MD², Shailendra Singh, MD^3
1West Virginia University Charleston Division, Charleston, WV; ²West Virginia University, Charleston Division, Charleston, WV; ³West Virginia University Health Sciences Center, Morgantown, WV

Introduction: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhea associated with frequent hospitalizations. Immunosuppressed patients are at higher risk of acquiring CDI due to their weakened immune system and require multiple hospitalizations due to recurrent CDI. The human immunodeficiency virus is one of the most common immunosuppressed states. There is limited literature about CDI in patients with concurrent human immunodeficiency virus (HIV) infection. We aimed to investigate the national estimate of 30 -day readmission rate for CDI in patients with HIV and its burden on healthcare expenditures using a large readmission database.

Methods: We queried the national readmission database (NRD) 2017 to identify all the patients hospitalized with Clostridium difficile infection (CDI) in patients with a concomitant diagnosis of HIV using the ICD-10 CM codes. We included all the patients age ≥ 18 years old who had non-elective admissions through January 1st to November 30th for 2017. The primary outcome was all-cause 30-day readmission rates of CDI in HIV patients identifying the most common principal diagnosis for readmission. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges for index and readmissions.

Results: A total of 678 adult patients with principal diagnosis CDI with concurrent HIV were identified in the NRD 2017. Mean age was calculated as 66.28 years, 38.18% of them were females and had Medicare (47.79 %) as the most common insurance. Baseline patients and hospital characteristics for index and 30-day readmission are given in table 1. A total of 661 (97.49%) patients survived to discharge from the index admission. The 30-day all-cause readmission rate was calculated at 31.46% (n=208). The most common principal diagnosis for readmissions was "clostridium difficile infection" (25.96%), followed by "Human immunodeficiency virus [HIV] diseases" (14.90%) and sepsis (5.76%). The all-cause inpatient mortality (7.21%) was high during the rehospitalization compared to (1.91%) in the index hospitalization. The mean length of stay was also high (7.2 days) in readmissions compared to the index hospitalization (5.9 days).

Discussion: Our study demonstrated that one out of three patients with CDI with HIV get hospitalized again within 30 days. Close outpatient follow-up with appropriate interventions including infection prevention and prolonged duration of treatment can prevent thousands of dollars in healthcare utilizations.


Figure: Figure: Kaplan-Meier curve for 30-day all-cause readmission among patients with Clostridium Difficile Infection (CDI) and Human Immunodeficiency Virus (HIV)

Patient Characteristics	Index Admissions	30-day readmissions	p-value
No. of patients	678	208
Female (%)	38.18%	37.53%	p = 0.00
Mean age (SD)	66.28 yrs	51.01 yrs
Charlson Comorbidity Index Score
2	5.8%	2.5%
3 or more	84.71%	90.98%
Median Income (Zip Codes)			p = 0.0848
$1-$38,999	51.06%	53.04%
$39,000-$47,999	25.41%	18.78 %
$548,000-$62,999	15.91%	22.36%
>$ 63,000	07.61%	05.82%
Insurance Provider			p = 0.073
Medicare	47.79%	48.39%
Medicaid	34.63%	38.16%
Private	14.74%	07.83%
Hospital Characteristics
Hospital Teaching Status			p = 0.8144
Non-teaching	21.72%	20.86%
Teaching	78.28%	79.14 %
Hospital Bed Size (n,%)			p = 0.4235
Small	13.91%	10.56%
Medium	23.47 %	21.89%
Large	62.62%	67.55%
Hospital Location			p = 0.1807
Rural	67.17%	76.79 %
Urban	27.05%	20.67%
Outcomes
Mortality no. %	13(1.91%)	15 (7.21%)	p< 0.01
Length of Stav (Mean)	5.9 days	7.2 days	p< 0.01
Total Charges (Mean)	$51,027	$ 58,015.	p< 0.01

Table: Table: Patient and hospital characteristics for patients presenting with Clostridium Difficile Infection (CDI) and Human Immunodeficiency Virus (HIV).


Disclosures:
Abdullah Sohail indicated no relevant financial relationships.
Ahmad Khan indicated no relevant financial relationships.
Khadija Naseem indicated no relevant financial relationships.
Mujtaba Bhinder indicated no relevant financial relationships.
Adil Memon indicated no relevant financial relationships.
Shailendra Singh indicated no relevant financial relationships.


Abdullah Sohail, MD¹, Ahmad Khan, MD², Khadija Naseem, MD², Mujtaba Bhinder, MD², Adil Memon, MD², Shailendra Singh, MD³. P1170 - 30-Day Readmissions in Clostridium difficile Infections in Patients With Human Immunodeficiency Virus (HIV): A Large Database Retrospective Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.