Mantri Nikhitha, Patel Harish, Badipatla Kanthi Rekha, Sun Haozhe, Shaikh Danial, Gongati Sudharsan, Nayudu Suresh Kumar
Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA.
Clin Exp Gastroenterol. 2021 Jun 3;14:229-235. doi: 10.2147/CEG.S308862. eCollection 2021.
infection (CDI) is one of the most common health care-associated infections in the United States. Studies revealed a higher mortality when CDI is associated with liver cirrhosis. We aim to present the outcomes of CDI among patients with and without liver cirrhosis and to analyze the association of Model for End-Stage Liver Disease (MELD) and Child-Pugh (CPT) scoring with the severity of CDI.
A retrospective observational study was conducted in hospitalized patients with CDI diagnosed via a 2-step method - glutamate dehydrogenase (GDH) and toxin polymerase chain reaction (PCR). Patients with liver cirrhosis were identified based on ICD codes and chart review. MELD and CPT scores were calculated using laboratory parameters at the time of hospitalization. We compared CDI-related mortality in patients with and without cirrhosis and reviewed the CDI severity distribution in cirrhosis patients.
A total of 526 patients were included in the study, of which 478 (90.87%) were non-cirrhotic and 48 (9.13%) were cirrhotic patients. Mortality rate was higher in cirrhosis group compared to the non-cirrhosis group (39.6% vs. 14.6%,P = 0.001). Among cirrhosis patients, those who survived had lower MELD score compared to the expired group (14.9 vs. 18.58, P = 0.106). There was no correlation of mortality based on CPT score in the cirrhosis group (P = 0.062). In post hoc analysis comparing the severity of CDI to liver cirrhosis, cirrhosis patients are more likely to present with severe-complicated disease. Multivariate logistic regression identified liver cirrhosis, severe-complicated CDI and serum albumin level as independent predictors of mortality.
Our study noted a more severe disease presentation and higher mortality in patients with cirrhosis admitted with CDI. Further studies are required for better understanding of the clinical course of CDI in cirrhosis and to evaluate the need for early intervention in this patient group.
艰难梭菌感染（CDI）是美国最常见的医疗保健相关感染之一。研究表明，CDI与肝硬化相关时死亡率更高。我们旨在呈现伴有和不伴有肝硬化的患者中CDI的结局，并分析终末期肝病模型（MELD）和Child-Pugh（CPT）评分与CDI严重程度的关联。
对通过两步法（谷氨酸脱氢酶（GDH）和毒素聚合酶链反应（PCR））诊断为CDI的住院患者进行回顾性观察研究。根据国际疾病分类（ICD）编码和病历审查确定肝硬化患者。使用住院时的实验室参数计算MELD和CPT评分。我们比较了伴有和不伴有肝硬化的患者中与CDI相关的死亡率，并回顾了肝硬化患者中CDI严重程度分布情况。
本研究共纳入526例患者，其中478例（90.87%）为非肝硬化患者，48例（9.13%）为肝硬化患者。肝硬化组的死亡率高于非肝硬化组（39.6%对14.6%，P = 0.001）。在肝硬化患者中，存活者与死亡组相比MELD评分较低（14.9对18.58，P = 0.106）。肝硬化组中基于CPT评分的死亡率无相关性（P = 0.062）。在比较CDI与肝硬化严重程度的事后分析中，肝硬化患者更易出现严重复杂疾病。多因素逻辑回归确定肝硬化、严重复杂的CDI和血清白蛋白水平为死亡率的独立预测因素。
我们的研究指出，因CDI入院的肝硬化患者疾病表现更严重，死亡率更高。需要进一步研究以更好地了解肝硬化患者中CDI的临床病程，并评估该患者群体早期干预的必要性。
