P1168 - Outcomes of Acute Renal Failure in Clostridium difficile Infection Patients: Nationwide Inpatient Sample

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rajesh Essrani, MD

Lehigh Valley Health Network
Allentown, PA, United States

Rajesh Essrani, MD¹, Matthew J. Sullivan, DO²
¹Lehigh Valley Health Network, Allentown, PA; ²Eastern Pennsylvania Gastroenterology and Liver Specialists, Allentown, PA

Introduction: Clostridium Difficile Infection (CDI) is one of the most common nosocomial infections and is a frequent cause of morbidity and mortality among older adult hospitalized patients.

Methods: Data was obtained from the 2017 and 2018 National Inpatient Sample (NIS), the largest all-payer inpatient database in the United States, for outcomes of acute renal failure in patients admitted with a principal diagnosis of CDI. Possible contributing factors were added to limit the confounders in the analysis. Charlson Comorbidity Index (CCI) was utilized to account for comorbidities present during the hospital stay. The primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay (LOS) and cost utilization.

Results: There were 109,065 patients admitted with a principal diagnosis of CDI who were more than 18 years of age, and 35,773 patients had both CDI and acute renal failure (ARF). The mean age was 66 years, and the mean length of stay was 5.4 days.

Among patients admitted with CDI who developed ARF, there is an increased odds of mortality compared to patients without ARF irrespective of other variables and this is statistically significant (Odds Ratio (OR) 2.75, p = 0.000, 95% Confidence Interval (CI) 2.10 – 3.61). For each one-year increase in age among patients admitted with CDI, there is a 3% increased odds of mortality irrespective of other variables (Odds Ratio (OR) 1.03, p = 0.000, 95% Confidence Interval (CI) 1.02 – 1.04). History of congestive heart failure (CHF) also increased odds of mortality.

Patients with CDI and ARF had statistically increased mean LOS of 1.11 days while adjusting for other variables. Mean LOS was higher in patients with CHF and older patients. Mean LOS was shorter in patients with a history of smoking, hyperlipidemia, diabetes mellitus, prior myocardial infarction, chronic kidney disease, and patients admitted on a weekend.

The total charge for hospitalizations from ARF is increased by $10,571 (95% CI 8,300 – 12,842). The mean total charge was higher in patients with CHF. Patients with higher CCI had increased odds of mortality, LOS, and total inpatient hospital charge (Table 1).

Discussion: This retrospective study suggests worse outcomes in CDI patients with ARF. This highlights that ARF should be recognized early and appropriately treated to prevent poor outcomes. Some of the other variables had an interesting impact on the outcomes which should be explored by further studies.

Mortality
Variable (Mortality)	Odds Ratio	p-Value	95% Confidence Interval

Acute Renal Failure	2.75	0.000	2.10	3.61
Charlson Index	1.26	0.000	1.19	1.33
Coronary Artery Disease	1.05	0.769	0.77	1.42
Chronic Kidney Disease	0.58	0.002	0.41	0.82
Congestive Heart Failure	1.78	0.000	1.34	2.36
Smoking	0.63	0.003	0.46	0.85
Hyperlipidemia	0.68	0.005	0.52	0.89
Diabetes Mellitus	0.76	0.239	0.49	1.20
Obesity	0.72	0.151	0.47	1.13
Myocardial Infarction	0.54	0.019	0.32	0.90
Weekend Admission	1.00	0.982	0.76	1.33
Age	1.03	0.000	1.02	1.04
Female	0.86	0.257	0.67	1.12

Length Of Stay
Variable (Length Of Stay)	Coefficient	p-Value	95% Confidence Interval

Acute Renal Failure	1.11	0.000	0.92	1.30
Charlson Index	0.30	0.000	0.26	0.35
Coronary Artery Disease	-0.06	0.520	-0.24	0.12
Chronic Kidney Disease	-0.40	0.001	-0.63	-0.17
Congestive Heart Failure	0.62	0.000	0.40	0.84
Smoking	-0.41	0.000	-0.56	-0.27
Hyperlipidemia	-0.27	0.000	-0.40	-0.13
Diabetes Mellitus	-0.51	0.000	-0.71	-0.31
Obesity	0.03	0.763	-0.17	0.23
Myocardial Infarction	-0.69	0.000	-0.96	-0.42
Weekend Admission	-0.23	0.002	-0.38	-0.08
Age	0.02	0.000	0.01	0.02
Female	-0.05	0.517	-0.19	0.10

Total Charge
Variable (Total Charge)	Coefficient	p-Value	95% Confidence Interval

Acute Renal Failure	10571.37	0.000	8300.58	12842.16
Charlson Index	3172.10	0.000	2608.50	3735.70
Coronary Artery Disease	854.51	0.412	-1185.53	2894.55
Chronic Kidney Disease	-4583.48	0.001	-7358.82	-1808.15
Congestive Heart Failure	5161.14	0.000	2439.22	7883.05
Smoking	-4079.79	0.000	-5615.04	-2544.53
Hyperlipidemia	-608.83	0.434	-2135.77	918.10
Diabetes Mellitus	-2716.26	0.020	-5008.29	-424.23
Obesity	1685.85	0.254	-1210.44	4582.13
Myocardial Infarction	-7871.29	0.000	-10829.93	-4912.65
Weekend Admission	-497.01	0.579	-2254.53	1260.50
Age	-19.55	0.450	-70.34	31.23
Female	-1120.43	0.166	-2707.52	466.67

Table: Table 1: Mortality, LOS, and total charge

Disclosures:

Rajesh Essrani indicated no relevant financial relationships.

Matthew Sullivan indicated no relevant financial relationships.

Rajesh Essrani, MD¹, Matthew J. Sullivan, DO². P1168 - Outcomes of Acute Renal Failure in Clostridium difficile Infection Patients: Nationwide Inpatient Sample, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.