Internal Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Brunswick, NJ, the United States.
Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, the United States.
Ann Hepatol. 2024 Jul-Aug;29(4):101510. doi: 10.1016/j.aohep.2024.101510. Epub 2024 May 5.
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and can progress to non-alcoholic steatohepatitis (NASH) and, ultimately, cirrhosis. Clostridioides difficile is the most common nosocomial cause of diarrhea and is associated with worse clinical outcomes in other liver diseases, including cirrhosis, but has not been extensively evaluated in concomitant NAFLD/NASH.
We conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2017. Patients with a diagnosis of CDI, NAFLD, and NASH were identified using International Classification of Diseases (Tenth Revision) codes. The outcomes of our study include length of stay, hospitalization cost, mortality, and predictors of mortality.
The CDI and NASH cohort had a higher degree of comorbidity burden and prevalence of peptic ulcer disease, congestive heart failure, diabetes mellitus, and cirrhosis. Patients with NASH and CDI had a significantly higher mortality rate compared to the CDI only cohort (mortality, 7.11 % vs. 6.36 %; P = 0.042). Patients with CDI and NASH were at increased risk for liver-related complications, acute kidney injury, and septic shock (P < 0.001) compared to patients with CDI only. Older age, intestinal complications, pneumonia, sepsis and septic shock, and liver failure conferred an increased risk of mortality among the CDI and NASH cohort.
Patients with NASH had a higher rate of liver-related complications, progression to septic shock, and mortality rate following CDI infection compared to the CDI only cohort.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病，可进展为非酒精性脂肪性肝炎（NASH），最终发展为肝硬化。艰难梭菌是医院获得性腹泻最常见的病原体，与其他肝脏疾病（包括肝硬化）的临床结局较差相关，但在合并 NAFLD/NASH 中尚未得到广泛评估。
我们使用 2015 年至 2017 年国家住院患者样本数据库进行了回顾性队列研究。使用国际疾病分类（第十版）代码识别艰难梭菌感染（CDI）、NAFLD 和 NASH 的诊断患者。我们研究的结果包括住院时间、住院费用、死亡率和死亡率的预测因素。
CDI 和 NASH 队列的合并症负担和消化性溃疡病、充血性心力衰竭、糖尿病和肝硬化的患病率更高。与仅 CDI 队列相比，NASH 和 CDI 患者的死亡率显著更高（死亡率，7.11%比 6.36%；P=0.042）。与仅 CDI 患者相比，患有 CDI 和 NASH 的患者发生与肝脏相关的并发症、急性肾损伤和感染性休克的风险显著增加（P<0.001）。与仅 CDI 队列相比，年龄较大、肠道并发症、肺炎、败血症和感染性休克以及肝功能衰竭使 CDI 和 NASH 队列的死亡率增加。
与仅 CDI 队列相比，患有 NASH 的患者在艰难梭菌感染后发生与肝脏相关的并发症、进展为感染性休克和死亡率的风险更高。
