Outcomes associated with Clostridium difficile infection in patients with chronic liver disease
Outcomes associated with Clostridium difficile infection in patients with chronic liver disease
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DOI：
10.1017/s0950268818001036
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发表时间：
2018-07-01
影响因子：
4.2
通讯作者：
Garey, Kevin W.
中科院分区：
文献类型：
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作者：
Dotson, Kierra M.;Aitken, Samuel L.;Garey, Kevin W.
慢性肝病(CLD)患者经常暴露于艰难梭菌感染(CDI)的危险因素，但CDI在这一人群中的发病率和病原学尚不清楚。这项研究的目的是评估潜在CLD患者的CDI的发生率、疾病表现和预后。使用卫生保健和利用项目国家住院患者样本(HCUP-NIS)2009年数据集来识别发生CDI的CLD患者以及与CDI匹配的非CLD患者。使用NIS数据集，慢性阻塞性肺病患者的CDI发生率为189.4/10000，而非慢性阻塞性肺病患者为83.7/10000(P<；0.001)。与非慢性阻塞性肺病、共病相匹配的CDI对照组相比，慢性阻塞性肺病合并CDI的患者住院死亡率更高(8.8%比18.6%，P<；0.001)，住院时间延长1.19d(P<；0.001)，总费用增加8632美元(P<；0.001)。在使用德克萨斯州休斯敦(2006年至2016年)患有慢性疾病和慢性疾病相关疾病的住院患者(n=41)与患有慢性疾病但没有慢性疾病的患者(n=111)的第三方病例数据库进行的单独分析中，慢性疾病患者的Charlson共病指数显著高于非慢性疾病患者(P<；0.0001)，但与非慢性疾病患者相比，慢性疾病和慢性疾病相关疾病的危险因素相似。总之，CDI相关危险因素几乎普遍存在于CLD人群中。CDI在这一人群中导致了更糟糕的结果。
Patients with chronic liver disease (CLD) have frequent exposure to Clostridium difficile infection (CDI) risk factors but the incidence and aetiology of CDI on this population is poorly understood. The aim of this study was to assess the incidence, disease presentation and outcomes of CDI in patients with underlying CLD. The Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) 2009 dataset was used to identify patients with CLD who developed CDI along with matched non-CLD patients with CDI. Using the NIS dataset, the incidence rate of CDI was 189.4/10 000 discharges in CLD patients vs. 83.7/10 000 discharges in the non-CLD matched cohort (P < 0.001). Compared with non-CLD, comorbidity-matched controls with CDI, CLD patients with CDI had higher likelihood of in-hospital mortality (8.8% vs. 18.6%, P < 0.001), increased length of stay by 1.19 days (P < 0.001) and increased total costs by $8632 (P < 0.001). In separate analyses using a tertiary case database of hospitalised patients in Houston, Texas (2006-2016) with CLD and CDI (n = 41) compared with patients with CDI but not CLD (n = 111), CLD patients had significantly higher Charlson comorbidity index (P < 0.0001) but similar risk factors for CDI and CDI-related disease presentation compared with non-CLD patients. In conclusion, CDI-related risk factors were almost universally present in the CLD population. CDI resulted in worse outcomes in this population.