Samantha Hitchcock

 infection leads to higher rates of overall mortality among patients with cirrhosis compared to those who do not, according to a study presented by lead-author Russel Rosenblatt, MD, department of medicine, Weill Cornell Medicine, at the 2018 American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 9-13, 2018, in San Francisco, California.

“Patients with cirrhosis are vulnerable to 

 infection, frequent bacterial infections, and dysbiosis due to their functional immunosuppression,” the investigators of the study wrote. “Despite data demonstrating that 

 infection is becoming more common and is associated with a higher mortality in patients with cirrhosis, there is no data assessing its recurrence and readmissions in this patient population.”

Data were collected from Washington, Florida, and New York State Inpatient Databases (SID) between 2009 to 2013 for the study. To be included in the analysis, patients must have had an International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code consistent with cirrhosis or its complications, including ascites, esophageal varices, hepatic encephalopathy, and hepatocellular carcinoma. Patients who underwent prior liver transplant were excluded from the study.

The primary endpoint was hospital readmission within 30 and 90 days, with secondary endpoints of total inpatient morality and multiple readmission.

Of the 123,546 patients meeting the criteria for eligibility, 1,827 (1.5%) had 

 infection and 121,719 (98.5%) did not. The study identified notable higher rates of mortality among patients with C diff at index admission than those without C diff infection (17.9% versus 7.4%, respectively; P<.001). 

For patients who did not die or who were transplanted at index admission, those with 

 infection had higher admission rates within 30 days compared with those without 

 infection (21.1% versus 19.3%, respectively; P = .03). However, the percentage of patients who readmitted within 90 days of index admission were similar between the 2 arms (31.7% versus 30.2%, respectively).

 infection has significant consequences for patients with cirrhosis,” the investigators wrote.

 infection at 30 days was 17.2% for patients who presented with 

infection at index admission compared with 0.8% for those who did not (P<.001). Similar rates were noted at 90 days (21.7% versus 1.1%, respectively; P<.001), and inpatient death during readmission.

Higher overall mortality was seen for patients with 

 infection at index admission (24.0% versus 13.1%, respectively; P<.001); however, there were no significant differences noted in overall readmission rates.

“Prevention, early recognition, and aggressive treatment strategies need to be reexamined for those patients with cirrhosis and 

 infection to prevent deleterious consequences,” the investigators concluded.

The study is entitled, “The Effect of Clostridium Difficile Infections on Readmissions in Patients with Cirrhosis.”

 Infection Associated With Higher Mortality Rates in Patients With Cirrhosis

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Clostridium difficile infection leads to higher rates of overall mortality among patients with cirrhosis compared to those who do not, according to a new study.

Samantha Hitchcock

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