Malnutrition Results in Worse Outcomes for C Difficile Patients

Darian Fard, MD

Patients with Clostridium difficile infections (CDI) who also are malnourished are at an increased risk of a number of negative outcomes, including higher mortality, increased hospital lengths of stay, and higher costs.

A team, led by Darian Fard, MD, University of Missouri-Columbia Hospital, evaluated in-hospital outcomes for malnourished patients admitted to the hospital with CDI.

“Clostridioides difficile infection (CDI) is the most common healthcare-related diarrhea and is associated with substantial morbidity and mortality,” the authors wrote. “Malnutrition is common amongst patients with CDI, and some studies have suggested that it may increase CDI risk due to secondary immunodeficiency.”

Limited Data

However, there is very limited data on the direct impact of malnutrition on patients who develop CDI.

In the retrospective study presented during the 2022 American College of Gastroenterology (ACG) Annual Meeting in Charlotte, investigators examined adults hospitalized with a diagnosis of CDI from a Nationwide Inpatient Sample from 2016-2019.

The patients were stratified based on the presence of malnutrition using the International Classification of Diseases (ICD-10) codes.

The investigators sought primary outcomes of in-hospital mortality and secondary outcomes of intensive care unit (ICU) admissions, acute kidney injuries (AKI) requiring dialysis, the length of stay, and hospital charges.

The team adjusted for confounding factors of outcomes using multivariate regression analysis.

A Large Patient Population

The study included 1,267,805 patients admitted to the hospital with CDI, 15.17% of which had a documented diagnosis of malnutrition.

Overall, this subset of patients had a higher mortality rate, more ICU admissions, were more likely to have an AKI requiring dialysis, a longer mean length of stay, and higher hospital charges compared to patients with CDI without malnutrition.

After conducting a multivariate analysis, the investigators found malnutrition was an independent predictor of worse outcomes for patients with CDI.

The adjusted odds ratio (aOR) was 1.77 for mortality (P <0.001), 1.69 for ICU admission (P <0.001), and 1.65 for AKI requiring dialysis (P <0.001), while the adjusted mean for length of stay and total hospital charges increased by 5.48 days and $64,150, respectively, in the malnutrition group, compared to those without malnutrition.

“Our results highlight the impact of malnutrition on patients admitted to the hospital with CDI,” the authors wrote. “The increased in-hospital mortality and complications underline the importance of identifying malnourished patients as a higher-risk group and suggests that nutritional replenishment may be one strategy to decrease adverse outcomes in patients with or at increased risk of CDI.”

The study, “A0099 - The Impact of Malnutrition on Patients Hospitalized With Clostridioides difficile Infection,” was published online by ACG.