P0691 - In-Hospital Mortality, Outcomes, and Cost Analysis of Hospitalized C. difficile Patients With Inflammatory Bowel Disease: A Nationwide Sample Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Onyinye Ugonabo, MD

Marshall University Joan C. Edwards School of Medicine
Huntington, WV

Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Khwaja S. Haq, MD³, Pramod Pantangi, MD², Mohamed Hammad, MD², Shima Ghavimi, MD⁴
¹Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²Marshall University, Huntington, WV; ³Wellstar Spalding Regional Medical Center, Griffin, GA; ⁴Cedar Valley Digestive Health Center, Cedar Falls, IA

Introduction: Clostridium difficile (C. diff) is the leading cause of nosocomial diarrhea and has been shown to impact about 13 in every 1000 hospitalized patients. The occurrence of C. diff and Inflammatory bowel disease (IBD) have been linked to disruption of the gut microbiota (dysbiosis) which may explain the parallel rise of C. diff infection in IBD patients. Our study aimed to analyze the cost burden and clinical outcomes of hospitalized IBD patients with C. diff infections.

Methods: 240,550 adults hospitalized with Crohn’s disease or Ulcerative colitis were analyzed using the NIS data from 2016-2019. Patients were classified into a group with C. diff and a group without C. diff and variables like Age, gender, race, diabetes mellitus, nicotine use, anemia, end-stage renal disease (ESRD), thrombocytopenia, albumin abnormality, peritoneal abscess, toxic megacolon, gastrointestinal bleed, vesicovaginal fistula, anorectal fistula, vesicointestinal fistula, mortality, and hospitalization cost were analyzed using the two-sample t test, chi-square test, and multiple linear regression. P value < 0.05 was considered statistically significant.

Results: We found that compared to men, women hospitalized with IBD are more likely to get infected with C. diff (4.2% vs 4.5%, P = < 0.001). Older IBD patients (Mean age of 53.1) are at risk compared to other age groups (P = < 0.001). Whites had the least C. diff rates compared to blacks, Hispanics, Asians, Native America, and others (4.2% vs 4.7% vs 5.6% vs 5.3% vs 4.4% vs 4.5%, P = < 0.001). IBD patients with anemia and thrombocytopenia had a significantly higher rate of C. diff infection (P = < 0.001). Interestingly, nicotine dependence and peritoneal abscess protected against C. diff infection (P = < 0.001 and 0.008). The average total hospital cost among IBD patients with C. diff was $20,254 higher compared to those without C. diff after controlling the effects of the variables - age, gender, race, nicotine status, anemia, ESRD, peritoneal abscess, thrombocytopenia, gastrointestinal bleed, and vesicovaginal fistula. The odds of mortality among IBD patients with C. diff was more than twice compared to those without C. diff (OR = 2.1, p = < 0.001).

Discussion: IBD patients remain at increased risk of C. diff infection and more hospital expenses. Hence, clinicians should rule out C. diff infection first in every IBD patient presenting with disease flare-ups or diarrhea.

A
Variables	Mean	Std Err
Age in years at admission	52.4	0.05
Total charges	56650.6	201.75

Total Sample size (n) =28476826

	n=240550	%
Gender (female)	135183	56.21
Race
White	182555	78.39
Black	26630	11.44
Hispanic	14607	6.27
Asian or Pacific Islander	2794	1.2
Native American	881	0.38
Others	5410	2.32

Clostridium difficile	10487	4.36
Type 1 Diabetes	613	0.25
Type 2 Diabetes	8004	3.33
Nicotine	33671	14
Anemia	26752	11.12
End Stage Renal Disease	4603	1.91
Thrombocytopenia	7634	3.17
Albumin Abnormality	13	0.01
Peritoneal Abscess	3511	1.46
Toxic Megacolon	73	0.03
Gastrointestinal Hemorrhage	3038	1.26
Vesicovaginal fFistula	25	0.01
Anorectal Fistula	159	0.07
Vesicointestinal Fistula	700	0.29
Death	3558	1.48

B
Variables	No Clostridium difficile	Clostridium difficile	Pvalue**
Age	52.34 (0.05)	53.1 (0.25)	0.002
Total Cost	55775.7 (200.0)	75866.9 ()	< 0.001
Gender			< 0.001
Male	100925 (95.8)	4390 (4.2)
Female	129089 (95.5)	6094 (4.5)
Race			< 0.001
White	174879 (95.8)	7676 (4.2)
Black	25382 (95.3)	1248 (4.7)
Hispanic	13795 (94.4)	812 (5.6)
Asian or Pacific Islander	2645 (94.7)	149 (5.3)
Native American	842 (95.6)	39 (4.4)
Others	5165 (95.5)	245 (4.5)
Type 1 Diabetes			0.957
No	229477 (95.6)	10460 (4.4)
Yes	586 (95.6)	27 (4.4)
Type 2 Diabetes			0.619
No	222399 (95.6)	10147 (4.4)
Yes	7664 (95.8)	340 (4.3)
Nicotine			< 0.001
No	197659 (95.5)	9220 (4.5)
Yes	32404 (96.2)	1267 (3.8)
Anemia			< 0.001
No	204759 (95.8)	9039 (4.2)
Yes	25304 (94.6)	1448 (5.4)
End Stage renal disease			< 0.001
No	225781 (95.7)	10166 (4.3)
Yes	4282 (93)	321 (7)
Thrombocytopenia			< 0.001
No	222840 (95.7)	10076 (4.3)
Yes	7223 (94.6)	411 (5.4)
Albumin Abnormality			0.440
No	230051 (95.6)	10486 (4.4)
Yes	12 (92.3)	1 (7.7)
Peritoneal Abscess			0.008
No	226673 (95.6)	10366 (4.4)
Yes	3390 (96.6)	121 (3.5)
Toxic Megacolon			0.252
No	229995 (95.6)	10482 (4.4)
Yes	68 (93.2)	5 (6.9)
Gastrointestinal Hemorrhage			< 0.001
No	227217 (95.7)	10295 (4.3)
Yes	2846 (93.7)	192 (6.3)
Vesicovaginal Fistula			0.022
No	230042 (95.6)	10483 (4.4)
Yes	21 (84)	4 (16)
Anorectal Fistula			0.118
No	229915 (95.6)	10476 (4.4)
Yes	148 (93.1)	11 (6.9)
Vesicointestinal Fistula			0.306
No	229388 (95.6)	10462 (4.4)
Yes	675 (96.4)	25 (3.6)
Died during Hospitalization			< 0.001
No	226731 (98.6)	10140 (96.7)
Yes	3215 (1.4)	343 (3.3)

C
Variables	Estimate	P-value
Clostridium difficile
Yes	20253.8	< .0001
No	Reference	.
Age	190.0	< .0001
Gender
Female	-6793.7	< .0001
Male	Reference
Race
Black	1360.8	0.077
Hispanic	15715.7	< .0001
Asian or Pacific Islander	21532.2	< .0001
Native American	10162.3	0.010
Others	10524.4	< .0001
Whites	Reference
Nicotine
Yes	-10003.1	< .0001
No	Reference
Anemia
Yes	3677.0	< .0001
No	Reference
Renal
Yes	35980.5	< .0001
No	Reference
Peritoneal Abscess
Yes	97785.2	< 0.001
No	Reference
Thrombocytopenia
Yes	35875.9	< .0001
No	Reference
Gastrointestinal Hemorrhage
Yes	18041.1	< .0001
No	Reference
Vesicovaginal Fistula
Yes	84031.3	< .0001
No	Reference

D
Variables	OR (CI)	P-value
Clostridium Difficile Yes vs No	2.1 (1.8, 2.4)	< .0001
Age	1 (1.0, 1.1)	< .0001
Female vs Male	0.8 (0.8, 0.9)	< .0001
Race
Black vs White	1.1 (1, 1.3)	0.1262
Hispanic vs White	1.3 (1.1, 1.5)	0.8211
Asian Pacific Islander vs White	1.4 (1.0, 1.9)	0.468
Native American vs White	1.7 (0.9, 3)	0.2633
Others vs White	1.2 (0.9, 1.6)	0.6915
Nicotine user vs non-user	0.9 (0.8, 1)	0.0926
Anemia vs no	1.1 (1, 1.2)	0.1634
Peritoneal Abscess vs no	2.3 (2, 2.7)	< .0001
Renal disease vs no disease	2.4 (1.8,3.2)	< .0001
Thrombocytopenia vs no	2.8 (2.4, 3.2)	< .0001
Gastrointestinal Hemorrhage vs no	3 (2.5, 3.7)	< .0001
Vesicovaginal fistula vs no	6 (1.3, 27.9)	0.0217

Table: (A): Descriptive summary of patients with ulcerative colitis and Crohn's disease. (B): Univariate analysis- Clostridium difficile versus other variables. (C): Multiple linear regression of total hospital cost on clostridium difficile. (D): Multiple logistic regression analysis of mortality on clostridium difficile.

Disclosures:

Onyinye Ugonabo indicated no relevant financial relationships.

Rajan Lamichhane indicated no relevant financial relationships.

Khwaja Haq indicated no relevant financial relationships.

Pramod Pantangi indicated no relevant financial relationships.

Mohamed Hammad indicated no relevant financial relationships.

Shima Ghavimi indicated no relevant financial relationships.

Onyinye Ugonabo, MD¹, Rajan Lamichhane, PhD, MSc², Khwaja S. Haq, MD³, Pramod Pantangi, MD², Mohamed Hammad, MD², Shima Ghavimi, MD⁴. P0691 - In-Hospital Mortality, Outcomes, and Cost Analysis of Hospitalized C. difficile Patients With Inflammatory Bowel Disease: A Nationwide Sample Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.