Chronic Kidney Disease as a Predictor of Mortality in Hospitalized Inflammatory Bowel Disease Patients With Clostridioides difficile Infection

TL;DR

This study finds that patients with inflammatory bowel disease and kidney failure have higher mortality from Clostridioides difficile infection.

Contribution

The study identifies end-stage renal disease as a significant mortality predictor in hospitalized IBD patients with CDI.

Findings

ESRD patients with IBD had significantly higher mortality from CDI compared to those without IBD.

CKD showed a non-significant trend toward higher mortality in IBD patients with CDI.

Propensity score matching confirmed the association between ESRD and increased mortality in IBD-CDI patients.

Abstract

Introduction

Clostridioides difficile infection (CDI) leads to significant morbidity and mortality in hospitalized patients. We aim to investigate whether chronic kidney disease (CKD) or end-stage renal disease (ESRD) are predictors of mortality in admitted patients with CDI, and whether the presence of inflammatory bowel disease (IBD) has any impact on the mortality rate.

Methods

The data of 133,099 hospitalized patients with CDI were analyzed from the National Inpatient Sample (NIS) database from 2016 to 2018. Baseline risk factors were identified using ICD-10 codes. Propensity score matching was used to match CKD/ESRD patients with patients without kidney disease based on age, gender, and IBD status (Crohn's disease or ulcerative colitis). A multivariable logistic regression model was used to establish the relationship between variables and adjusted for underlying risk factors. The primary endpoint was all-cause mortality among hospitalized patients with CDI, particularly those with IBD.

Results

Our cohort included 133,099 hospitalized patients with CDI, among whom 20,700 (15.6%) had CKD, 12,178 (9.1%) had ESRD, and 6104 (4.6%) had IBD. The mean age was 74, 63, and 63 years (p<0.001) in patients with CKD, ESRD, and those without kidney disease, respectively. CDI patients with ESRD had a higher proportion of males (6095, 50.3%), compared to those with CKD and without kidney disease (9494, 45.9%, and 40,876, 40.8%, respectively; p<0.001). Propensity score matching was performed, and the patients were matched on age, resulting in a 1:1 exact match for 32,878 patients. Logistic regression analysis showed that in CDI patients with IBD, CKD was associated with a statistically insignificant trend towards a higher all-cause mortality rate as compared to CDI patients without IBD (odds ratio, 1.682 vs odds ratio, 1.229, p>0.05). However, ESRD patients had a significantly higher all-cause mortality rate (Odds ratio, 3.738, 95% CI 2.175-6.425) among hospitalized CDI patients with IBD compared to those without IBD (odds ratio, 1.612, 95% CI 1.486-1.749) (p<0.05).

Conclusion

Kidney disease, particularly ESRD, is associated with a significant increase in mortality in CDI patients with IBD compared to those without IBD. These findings highlight the importance of aggressive CDI management in patients with IBD and ESRD.

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