# P-1015. Inpatient outcomes of Clostridioides Difficile infections in patients with Left Ventricular Assist Devices: A National Database Analysis

## TL;DR

This study finds that patients with heart pumps (LVADs) who get C. difficile infections face much higher risks of death, longer hospital stays, and higher costs compared to others.

## Contribution

The study is the first to analyze inpatient outcomes of C. difficile infections specifically in patients with left ventricular assist devices using a national database.

## Key findings

- Patients with LVADs and CDI had higher in-hospital mortality (12.9%) compared to those without LVADs (6.9%).
- Hospital stays for LVAD patients with CDI were significantly longer (mean 54.7 days) and more costly (mean $718,345) than for non-LVAD patients.
- Females with LVADs had lower inpatient mortality (OR 0.55) compared to males.

## Abstract

Left ventricular assist devices (LVAD) carry a risk of device component infection, and deep-seated or recurrent infections often require long-term antibiotics. Antibiotic use is associated with Clostridioides difficile infection (CDI), which can cause substantial morbidity and result in inpatient stays. This study aims to evaluate the incidence, epidemiology and outcomes of inpatient admissions for CDI in patients with LVADs.Table 1:Demographics and Characteristics of patients with C. difficile infection; LVAD: left ventricular assist device

Demographics and Characteristics of patients with C. difficile infection; LVAD: left ventricular assist device

The National Inpatient Sample (NIS) was queried for all inpatient admissions with a primary or secondary diagnosis of CDI between January 2021 to December 2022. Patients with an LVAD were identified using ICD-10 procedure and diagnosis codes. Demographics, outcomes, length of stay, and inpatient costs were recorded and analyzed using SPSS (v. 30, IBM). Weights assigned in NIS were used to calculate national estimates. Demographics and outcomes for patients with and without LVAD were compared using chi-square, and logistic regression performed to determine variables associated with inpatient mortality in the LVAD cohort.

A total of 432,235 admissions with a primary or secondary diagnosis of CDI were reported, of whom 530 (0.1%) occurred in patients with LVAD (Table 1). Patients with LVAD and CDI were younger (mean 58.5 vs. 65.1 years), more likely to be male (71.8% vs. 43.8%, p >0.001) and more likely to have a device-related infection (14.5% vs 0.3%, p< 0.001). Patients with LVAD had significantly higher in-hospital mortality (12.9% vs. 6.9%, p< 0.001), longer hospital stays (mean 54.7 vs. 15.3 days, p< 0.001), and higher cost of inpatient stay (mean $718,345 vs. $143,253, p< 0.001). In the LVAD cohort, females had lower inpatient mortality (OR 0.55, CI 0.30-0.99, p=0.044).

Inpatient admissions for CDI in patients with LVAD were a small proportion of all CDI episodes, however these patients had significantly higher inpatient mortality, length of stay and inpatient cost compared to patients without LVAD. Given the frequent need for prolonged antibiotic use in patients with LVADs, clinicians should remain vigilant about CDI risk and its potentially severe outcomes in this vulnerable population.

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