Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Clin Transl Gastroenterol. 2020 Jul;11(7):e00189. doi: 10.14309/ctg.0000000000000189.
Clostridioides difficile infection (CDI) is common in patients with cirrhosis and is associated with poor outcomes. CDI risk factors in this population have been well characterized; however, risk factors of recurrent CDI (R-CDI) after treatment have not been explored. We sought to estimate the incidence of R-CDI and its associated risk factors in patients with cirrhosis.
We performed a cohort study of patients with cirrhosis hospitalized with CDI between 2012 and 2016. We collected patient characteristics, including detailed information on the CDI, features of the underlying liver disease, and outcomes including R-CDI, hospital readmission, and mortality. R-CDI was defined as CDI occurring 2-8 weeks after the initial episode. Cox proportional hazards model was used to identify variables independently associated with the outcomes.
A total of 257 hospitalized patients with cirrhosis and CDI were included. CDI was community associated in 22.6%. The incidence of R-CDI was 11.9%. R-CDI was not significantly associated with medications at hospital admission or discharge. Independent risk factors of R-CDI included increased Charlson Comorbidity Index (hazard ratio [HR] 1.30; 95% confidence interval [CI]: 1.09-1.55) and use of lactulose (HR 2.58; 95% CI: 1.09-6.09). The 30-day readmission rate was 37%, and readmission was associated with increased Charlson Comorbidity Index (HR 1.12; 95% CI: 1.03-1.23) and Model for End-Stage Liver Disease score (HR 1.04; 95% CI: 1.01-1.07). The 90-day mortality was 22.8%.
In patients with cirrhosis, R-CDI is associated with comorbidity burden and lactulose use. Attention to these factors might aid clinicians in efforts to prevent R-CDI and improve outcomes in this population.
艰难梭菌感染（CDI）在肝硬化患者中很常见，与不良预后相关。该人群中 CDI 的危险因素已得到充分描述；然而，治疗后复发性 CDI（R-CDI）的危险因素尚未得到探索。我们旨在评估肝硬化患者 R-CDI 的发生率及其相关危险因素。
我们对 2012 年至 2016 年期间因 CDI 住院的肝硬化患者进行了队列研究。我们收集了患者特征，包括 CDI 的详细信息、基础肝病的特征以及结局，包括 R-CDI、医院再入院和死亡率。R-CDI 定义为初始发作后 2-8 周发生的 CDI。使用 Cox 比例风险模型确定与结局独立相关的变量。
共纳入 257 例肝硬化合并 CDI 的住院患者。社区获得性 CDI 占 22.6%。R-CDI 的发生率为 11.9%。R-CDI 与入院或出院时的药物无显著相关性。R-CDI 的独立危险因素包括Charlson 合并症指数增加（风险比[HR] 1.30；95%置信区间[CI]：1.09-1.55）和乳果糖的使用（HR 2.58；95% CI：1.09-6.09）。30 天再入院率为 37%，再入院与 Charlson 合并症指数增加（HR 1.12；95% CI：1.03-1.23）和终末期肝病模型评分（HR 1.04；95% CI：1.01-1.07）相关。90 天死亡率为 22.8%。
在肝硬化患者中，R-CDI 与合并症负担和乳果糖的使用相关。关注这些因素可能有助于临床医生努力预防 R-CDI，并改善该人群的结局。
