Patients With Cirrhosis, C difficile Infection Experience More Hospital Readmissions

One-third of patients with cirrhosis who were also infected with Clostridium difficile were readmitted within 30 days, usually because of recurrent C difficile infection, according to a recent nationwide study of hospitalized patients.

For the study, investigators from The Ohio State University utilized the Nationwide Readmissions Database to study patients hospitalized with C difficile infection. They gathered personal characteristics, surgical rates, and outcomes, from the database in order to classify the patients by their cirrhosis status. According to the investigators, among hospitalized patients with C difficile infection, 29.1% are readmitted within 30 days and 44.8% within 90 days. Furthermore, over one-third of patients who were readmitted had recurrent C difficile infection as the principle cause of readmission. Complications related to C difficile infection such as psueomembranous colitis, toxic megacolon, colonic perforation, and death, added to the “increasingly worrisome morbidity and mortality,” the study authors wrote.

The study results indicated that more than 366,000 patients were hospitalized for C difficile infection. Of that group of patients, about 12,000 (3.4%) had cirrhosis, and two-thirds of those were decompensated.

Patients infected with C difficile, but without cirrhosis, fared better than patients infected with C difficile with cirrhosis.

For example, the researchers observed that 30-day readmission rates were 33% in cirrhosis patients versus 24% in non-cirrhosis patients. Additionally, index admission mortality and calendar-year mortality were higher in patients with cirrhosis compared to those without cirrhosis.

“The most surprising observation we discovered was the magnitude of worse outcomes in those with cirrhosis compared to those without cirrhosis after a hospitalization for C difficile infection,” study author Andrew J. Kruger, DO, told MD Magazine^®. “Our hypothesis was that those with cirrhosis would have worse outcomes, but we did not expect it to be so severe.”

The most common causes of readmission for patients was recurrent C difficile infection (46%) and cirrhosis-related complications (34.6%). Patients with decompensated cirrhosis were more likely to be readmitted to the hospital within 30 days than patients with compensated cirrhosis.

“We found that early readmission (within 30-days) was the strongest predictor of calendar-year mortality,” Dr. Kruger continued. “Therefore, if physicians are able to understand what leads to readmissions, then perhaps we can prevent readmissions and mortality in the future.”

Some of the factors that were able to predict index admission mortality included cirrhosis status, index colectomy, and decompensation. The investigators also found that 30-day readmission and decompensated cirrhosis independently predicted calendar-year mortality.

“Both the treatment and prevention of recurrent C difficile infection is a ‘hot topic’ in medicine, not just in the field of gastroenterology and hepatology,” Dr. Kruger concluded. “As the medical community continues its investigation of C difficile infection and how best to treat and prevent it, I expect that the rates of infection in patients with cirrhosis will decrease, as will C difficile infection-related readmissions and mortality. For now, future studies in cirrhotics can continue to focus on strategies to prevent both initial and recurrent C difficile infection.”

The paper, “Early Readmission Predicts Increased Mortality in Cirrhosis Patients After Clostridium difficile Infection,” was published in the Journal of Clinical Gastroenterology.