Journal of Gastroenterology Hepatology and Digestive Disorders
- ISSN: 2578-5494
Saman Hamid, Sophia Haroon Dar, Medha Rajamanuri, Daniel Ratanski, Brandon Stahl, Tony Varughese, Nooraldin Merza, Yousaf Zafar, Rehmat Ullah, Lauren Block, and Rosario Ligresti
Clostridium Difficile infection (CDI) is the leading cause of healthcare-associated infections. Hematopoietic stem cell transplant (HSCT) recipients are highly vulnerable to the development of CDI, due to their immunocompromised status and antimicrobial resistance.
Patients and Methods: A retrospective review of the healthcare cost and utilization project: national inpatient sample was conducted between 2008-2018. International classification of disease (ICD) codes identified variables, including CDI and other comorbidities. The Chi-square test was used to assess statistical significance between groups. The data was propensity-matched, and then multivariate logistic regression was used to analyze independent predictors of mortality, and length of stay and to predict the odds of developing complications, including graft vs. host disease (GVHD).
Results: A total of 144,253 HSCT recipients are included, of which 33,470 were diagnosed with Clostridium Difficile Colitis (CDC). The mortality rate fluctuated from 9.2% in 2009 and 4.8% in 2017 (p<0.05). Patients with CDC had higher odds of mortality (1.70 p<0.05). HSCT recipients with CDC had higher rates of almost all complications. CDC increased the odds of developing GVHD (1.30 p<0.05), and GVHD increased the odds of developing CDC (1.20 p<0.05). HSCT patients with CDC who develop GVHD have significantly increased odds of mortality (2.33 p<0.05).
Conclusion: CDC remains a significant contributor to morbidity and mortality in HSCT recipients. Our study is the largest to date to evaluate trends and predictors of mortality in this population. We illustrate how CDC increases the incidence of several complications, increasing the odds of mortality. GVHD has a bidirectional relationship with CDC. We recommend further evaluating prophylactic strategies to decrease CDC and GVHD to reduce the burden of morbidity and mortality in this population.