30-day readmission predicts mortality in hospitalized CDI patients with cirrhosis
A third of Clostridium difficile infection (CDI) patients with cirrhosis have been readmitted in a span of 30 days primarily due to recurrent CDI, a recent study has found. In addition, there is a high rate of mortality linked to CDI in patients with cirrhosis, in which a poor prognosis is predicted by decompensation and 30-day readmission.
A total of 12,274 out of 366,283 (3.4 percent) patients hospitalized with CDI had cirrhosis. Of these, 7,741 (63.1 percent) were decompensated. Among CDI patients, those with vs without cirrhosis had higher 30-day readmission rates (33 percent vs 24 percent), index admission mortality (5 percent vs 2.5 percent) and calendar-year mortality (9 percent vs 4 percent).
The most common reasons for readmission were recurrent CDI (46 percent) and cirrhosis-related complications (34.6 percent). Patients with decompensated cirrhosis had a greater risk of readmission within 30 days than those with compensated cirrhosis (odds ratio [OR], 1.19, 95 percent CI, 1.03–1.36).
In multivariable analyses, index colectomy (OR, 6.50, 1.61–26.24) and decompensation (OR, 3.61, 2.49–5.23) predicted index admission mortality among patients with cirrhosis. Thirty-day readmission (OR, 3.71, 2.95–4.67) and decompensated cirrhosis (OR, 1.49, 1.17–1.89) were also independent predictors of calendar-year mortality.
“Reducing [recurrent] CDI-related readmissions may potentially improve these outcomes,” the investigators said.
This study used the Nationwide Readmission Database (2011–2014) to identify hospitalized patients with CDI and differentiate them according to the presence of cirrhosis. Baseline characteristics, surgical rates and outcomes were obtained. The primary outcomes were readmission and mortality rates.