Clostridioides difficile Infection and Liver Cirrhosis – A Retrospective, Cohort Study

Abstract

Purpose Clostridioides difficile 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. Methods 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. Results 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. Conclusion 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.

Clostridioides difficile Induced Rhabdomyolysis Associated With Decompensated Cirrhosis

“… 5 Furthermore, patients with CD and decompensated cirrhosis with higher Model for End-Stage Liver Disease (MELD) scores had poorer outcomes. 6 , 7 Although, our patient had decompensated cirrhosis, his MELD score of 14 on admission and clinical recovery with treatment is consistent with somewhat compensated liver function. Interestingly, CD thrives in the setting of gut inflammation and patients with inflammatory bowel disease are four times more likely to acquire CD than the general population.…”

A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States

“…Hypoalbuminemia and high serum creatinine levels are also associated with kidney disease and are further risk factors for CDI. Liver disease was a risk factor for CDI and rCDI; liver cirrhosis has previously been reported as a risk factor for CDI, potentially linked to immune dysfunction and hospitalization [148,149]. Furthermore, CDI tends to be more severe in patients with cirrhosis, and has been linked to an increased risk of mortality [149].…”

Disordered Intestinal Microbial Communities During Clostridioides difficile Colonization and Subsequent Infection of Hepatic Cirrhosis Patients in a Tertiary Care Hospital in China

“…Studies indicate that patients with hepatic cirrhosis disease are more likely to contract C. difficile colonization and CDI (Eyre et al, 2013;Alasmari et al, 2014;Mantri et al, 2021). If asymptomatic carriers are common among hospitalization patients and put them at elevated risk of going from colonization to clinical infection, then prevention of progression can reduce the rate of hospitalonset CDI.…”