Sleiman Joelle, Gaballa Andrew, Aslam Taimur, Rizvi Taqi A, El Sayegh Suzanne
Internal Medicine, Staten Island University Hospital, New York City, USA.
Internal Medicine, State University of New York Downstate Health Sciences University, New York City, USA.
Cureus. 2025 Jul 16;17(7):e88113. doi: 10.7759/cureus.88113. eCollection 2025 Jul.
Introduction Clostridioides difficile infection (CDI) leads to significant morbidity and mortality in hospitalized patients. We aim to investigate whether chronic kidney disease (CKD) or end-stage renal disease (ESRD) are predictors of mortality in admitted patients with CDI, and whether the presence of inflammatory bowel disease (IBD) has any impact on the mortality rate. Methods The data of 133,099 hospitalized patients with CDI were analyzed from the National Inpatient Sample (NIS) database from 2016 to 2018. Baseline risk factors were identified using ICD-10 codes. Propensity score matching was used to match CKD/ESRD patients with patients without kidney disease based on age, gender, and IBD status (Crohn's disease or ulcerative colitis). A multivariable logistic regression model was used to establish the relationship between variables and adjusted for underlying risk factors. The primary endpoint was all-cause mortality among hospitalized patients with CDI, particularly those with IBD. Results Our cohort included 133,099 hospitalized patients with CDI, among whom 20,700 (15.6%) had CKD, 12,178 (9.1%) had ESRD, and 6104 (4.6%) had IBD. The mean age was 74, 63, and 63 years (p<0.001) in patients with CKD, ESRD, and those without kidney disease, respectively. CDI patients with ESRD had a higher proportion of males (6095, 50.3%), compared to those with CKD and without kidney disease (9494, 45.9%, and 40,876, 40.8%, respectively; p<0.001). Propensity score matching was performed, and the patients were matched on age, resulting in a 1:1 exact match for 32,878 patients. Logistic regression analysis showed that in CDI patients with IBD, CKD was associated with a statistically insignificant trend towards a higher all-cause mortality rate as compared to CDI patients without IBD (odds ratio, 1.682 vs odds ratio, 1.229, p>0.05). However, ESRD patients had a significantly higher all-cause mortality rate (Odds ratio, 3.738, 95% CI 2.175-6.425) among hospitalized CDI patients with IBD compared to those without IBD (odds ratio, 1.612, 95% CI 1.486-1.749) (p<0.05). Conclusion Kidney disease, particularly ESRD, is associated with a significant increase in mortality in CDI patients with IBD compared to those without IBD. These findings highlight the importance of aggressive CDI management in patients with IBD and ESRD.
引言 艰难梭菌感染（CDI）会导致住院患者出现严重的发病率和死亡率。我们旨在调查慢性肾脏病（CKD）或终末期肾病（ESRD）是否为CDI住院患者死亡率的预测因素，以及炎症性肠病（IBD）的存在是否对死亡率有任何影响。方法 分析了2016年至2018年国家住院患者样本（NIS）数据库中133,099例CDI住院患者的数据。使用国际疾病分类第十版（ICD-10）编码确定基线风险因素。倾向评分匹配用于根据年龄、性别和IBD状态（克罗恩病或溃疡性结肠炎）将CKD/ESRD患者与无肾脏疾病的患者进行匹配。使用多变量逻辑回归模型建立变量之间的关系，并对潜在风险因素进行校正。主要终点是CDI住院患者的全因死亡率，特别是那些患有IBD的患者。结果 我们的队列包括133,099例CDI住院患者，其中20,700例（15.6%）患有CKD，12,178例（9.1%）患有ESRD，6104例（4.6%）患有IBD。CKD患者、ESRD患者和无肾脏疾病患者的平均年龄分别为74岁、63岁和63岁（p<0.001）。与CKD患者和无肾脏疾病的患者相比，ESRD的CDI患者男性比例更高（分别为6095例，50.3%；9494例，45.9%；40,876例，40.8%；p<0.001）。进行了倾向评分匹配，患者按年龄匹配，32,878例患者实现了1:1精确匹配。逻辑回归分析表明，在患有IBD的CDI患者中，与没有IBD的CDI患者相比，CKD与全因死亡率升高呈统计学上无显著意义的趋势相关（比值比，1.682对1.229，p>0.05）。然而，与没有IBD的住院CDI患者相比（比值比，1.612，95%置信区间1.486-1.749），患有IBD的住院CDI患者中ESRD患者的全因死亡率显著更高（比值比，3.738，95%置信区间2.175-6.425）（p<0.05）。结论 与没有IBD的患者相比，患有IBD的CDI患者中，肾脏疾病，尤其是ESRD，与死亡率显著增加相关。这些发现凸显了对患有IBD和ESRD的患者积极管理CDI的重要性。
