Chronic Pancreatitis Plus C. Difficile Infection Associated with Poorer Outcomes

Himanshu Kavani, MD

Chronic pancreatitis patients with clostridium difficile infection (CDI) have higher co-morbidities than those without CDI, according to a new study. Further, these patients demonstrated an increased mortality rate, longer length of hospital stay, and a higher hospitalization cost.

These findings were presented at the annual American College of Gastroenterology (ACG) 2020 conference.

According to the investigators, patients with chronic pancreatitis generally have high rates of unplanned recurrent hospitalizations, which may lengthen the hospital stay and subsequently increase risk of CDI.

A team led by Himanshu Kavani, MD, of St. Mary Medical Center, PA, assessed the Nationwide Inpatient Sample database and examined the clinical characteristics and outcomes of chronic pancreatitis patients with CDI.

They extracted data from October 2015-December 2017 using ICD 10 to identify such patients. SAS 9.4 was used to determine baseline characteristics, Elixhauser combordities, and outcomes between the cohorts with and without CDI. Further, they performed multivariate logistic regression to analyze adjusted mortality.

Overall, they evaluated a total of 159,615 chronic pancreatitis patients, with 4,550 (2.85%) presenting with concomitant CDI.

The investigators noted that a higher proportion of CDI patients were female (53.3%)—as compared to male (57.6%) in the non-CDI group (P<.0001). 

Additionally, a majority of the patients with CDI were ≥65 years of age (78.4%), whereas a majority of the non-CDI patients were <65 years (87.7%; P<.0001). 

Comorbidities were significantly higher in the chronic pancreatitis-CDI population, including diabetes mellitus (31.9% vs 29.7%, non-CDI; P<.0009), liver diseases (24.2% vs 17.1%; P<.0001), renal failure (18.1% vs 7.7%; P<.0001), weight loss (23.2% vs 10.6%; P<.0001), fluid and electrolyte disorders (57.6% vs 37.1%; P<.0001), and coagulopathy (13.2% vs 6.4%; P<.0001).

With that said, the authors noted that the most significant discrepancies in complications for the CDI cohort were dehydration and electrolyte disorders (63.1% vs 39.2%; P<.0001), septicemia (5.2% vs 1.2%; P<.0001), ascites (4.2% vs 2.3%; P<.0001), and hypoalbuminemia (2.6% vs 0.9%; P<.0001).

However, the complications that were more common in the non-CDI cohort were alcohol abuse (30.9% vs 37.8%, P < 0.0001) and acute pancreatitis (35.9% vs 82.9%, P < 0.0001).

As for the CDI patients, in-hospital mortality was 0.8% compared with 0.2% for non-CDI patients (P < 0.0001; adjusted OR, 1.49; 95% CI, 1.04–2.13; P = 0.02).

Similar trends were reported for median length of stay (5 days vs 3 days; P<.0001), median hospitalization costs ($8802 vs $5921, P<.0001), and disposition to home (68.8% vs 85.1%, P < 0.0001).

In light of these findings, Kavani and colleagues acknowledged that future studies should focus on prevention of CDI in this vulnerable population.

The study, “Clostridium difficile Infection in Patients With Chronic Pancreatitis: Comparison of Patient Characteristics and Outcomes,” was published online by ACG.