Predictors of In-Hospital Mortality of Patients Admitted Emergently for C. Difficile Colitis: A 10-Year Analysis of 174,074 Patients From NIS

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

11-1-2021

DOI

10.1016/j.jamcollsurg.2021.08.072

Journal Title

Journal of the American College of Surgeons

Department

Surgery

Abstract

Introduction

This study aimed to evaluate the association of mortality rate and hospitalization length in patients with C. difficile colitis.

Methods

Using the National Inpatient Sample (NIS) database, a total of 59,414 non-elderly and 114,660 elderly patients that had an emergency admission for Clostridium difficile-associated colitis were identified. Multivariable generalized additive model (GAM) was used to draw the association between hospital length of stay (HLOS) and in-hospital mortality. The model was adjusted for age, sex, race, zip code of residence, income quartile, NIS severity index, and the comorbidities.

Results

The mean age (SD) of non-elderly and elderly populations were 49 (12) and 79 (8) years, respectively. The female population consisted of 60% nonelderly and 65% elderly patients. Of these, 545 nonelderly (0.9%) and 4,612 elderly (4.0%) patients died during the study period. HLOS had a J-shaped association with mortality in non-elderly and a V-shaped association in elderly populations. Both populations demonstrated an increased mortality after day six. A multivariable logistic model built on patients who stayed in hospital for ≥six days, showed an OR of 1.065 in both populations. Coagulopathy, fluid/electrolyte disorders, metastatic cancer, pulmonary circulation disorders, renal failure, and weight loss were most strongly associated with mortality in nonelderly patients. In the elderly population, congestive heart failure, coagulopathy, metastasis, and weight loss had the strongest association with mortality.

Conclusion

In-hospital mortality among non-elderly and elderly patients with the primary diagnosis of C. difficile colitis increased directly proportional to HLOS after the sixth day of admission.

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