The Impact of Gastroesophageal Disease on Clostridium difficile Infection Hospitalization: A Nationwide Analysis From the United States

TL;DR

This study finds that patients hospitalized with Clostridium difficile infection and gastroesophageal reflux disease have better outcomes, including lower mortality and hospital costs.

Contribution

This is the first nationwide analysis showing that GERD is associated with reduced in-hospital mortality and complications in CDI patients.

Findings

Patients with CDI and GERD had lower inpatient mortality (0.66% vs. 1.46%) and reduced hospital charges ($39,599 vs. $43,589).

GERD was associated with lower rates of septic shock, acute kidney injury, and intestinal perforation in CDI patients.

CDI patients with GERD had a higher rate of ileus compared to those without GERD.

Abstract

Background

Enterocolitis due to Clostridium difficile infection (CDI) is one of the most common infectious causes of healthcare-associated diarrhea and a significant cause of morbidity and mortality among hospitalized patients. Gastroesophageal reflux disease (GERD) is notable for its high prevalence, variety of clinical presentations, and underrecognized morbidity. It is widely treated with acid suppression, both with over-the-counter and prescription medications. There are no studies evaluating the impact of GERD on CDI hospitalization. In this study, we aimed to analyze the influence of concomitant GERD on patients hospitalized for CDI enterocolitis.

Methodology

This was a retrospective, observational study where we extracted data from 2016 to 2020 from the National Inpatient Sample database. We included all patients hospitalized with a primary discharge diagnosis of CDI with or without a secondary diagnosis of GERD. We compared the demographics, comorbidities, and in-hospital outcomes between these two groups.

Results

This study identified 239,603 hospitalizations with a discharge diagnosis of CDI. Of these, 67,000 (28%) had a concurrent diagnosis of GERD. Patients with GERD had a higher prevalence of hypertension (41% vs. 35.5%, p < 0.01), hyperlipidemia (50% vs. 36.5%, p < 0.01), obesity (13.7% vs. 10.5%, p < 0.01), coronary artery disease (24.4% vs. 19.6%, p < 0.01), and chronic kidney disease (20.7% vs. 19.2%, p < 0.01). Notably, inpatient mortality was lower in CDI hospitalizations with GERD (0.66% vs. 1.46%, p < 0.01). The total hospital charge was reduced in the CDI with GERD group in comparison to the CDI without GERD group (39,599 vs. 43,589, p < 0.01). The length of hospital stay was similar between the two groups (5.3 vs. 5.4 days, p = 0.07). Regarding complications, CDI hospitalizations with GERD demonstrated lower rates of hypovolemic shock (0.5% vs. 0.73%, p = 0.06), septic shock (0.6% vs. 1.05%, p < 0.01), acute kidney injury (1.48% vs. 2.04%, p < 0.01), intestinal perforation (0.008% vs. 0.16%, p = 0.03), and lactic acidosis (0.008% vs. 0.16%, p = 0.03). Conversely, CDI patients with GERD had a higher rate of ileus (2.66% vs. 2.16%, p < 0.01).

Conclusions

Patients with CDI and concurrent GERD exhibited favorable in-hospital outcomes in terms of complication rates, mortality, and total hospital charges. Further research is required to comprehensively explore and validate these findings.