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MELD is the only predictor of short-term mortality in cirrhotic patients with C. difficile infection

Simon J Hong1, Paul Feuerstadt2, Lawrence J Brandt1

  • 1Division of Gastroenterology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|September 3, 2018
PubMed
Abstract

Insights

Patients with cirrhosis and Clostridium difficile infection (CDI) face higher short-term mortality. The Model for End-Stage Liver Disease (MELD) score is the sole predictor of this increased risk.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Clostridium difficile infection (CDI) is a prevalent nosocomial infection in the US.
  • Cirrhotic patients with CDI exhibit a significantly increased risk of adverse outcomes.
  • Understanding CDI's impact on cirrhosis patients is crucial for improving clinical management.

Purpose of the Study:

  • To assess the effect of CDI on short-term mortality in patients with cirrhosis.
  • To identify key predictors of mortality among cirrhotic patients diagnosed with CDI.

Main Methods:

  • Retrospective analysis of cirrhotic patients with diarrhea and C. difficile toxin assay at Montefiore Medical Center (2010-2014).
  • Data collection included demographics, comorbidities, medications, laboratory values, and outcomes.
  • Statistical analysis to compare outcomes between CDI-positive and CDI-negative groups and identify mortality predictors.

Main Results:

  • Of 701 patients, 183 had CDI. CDI patients were older and had more comorbidities like CKD and heart failure.
  • Thirty-day mortality was higher in the CDI group (23.0%) compared to the non-CDI group (16.6%).
  • Multivariate analysis identified the Model for End-Stage Liver Disease (MELD) score as the only significant predictor of 30-day mortality (HR: 1.04).

Conclusions:

  • Cirrhotic patients with CDI face a greater risk of 30-day mortality.
  • The MELD score is the primary independent predictor of mortality in this population.
  • Disease severity stratification using MELD scores is recommended for managing cirrhotic patients with CDI.
Keywords:
CirrhosisColitisInfection

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