Mortality predictors of Clostridioides difficile infection in inflammatory bowel disease

Introduction: Inflammatory bowel disease (IBD) is characterized by chronic relapsing and remitting inflammation of the gastrointestinal tract. Clostridioides difficile is a Gram-positive, spore-forming, anaerobic bacillus. C. difficile infection (CDI) is the leading cause of colitis and hospital-acquired diarrhea. Prior studies have suggested worse outcomes among IBD patients with CDI, though data remain conflicting. Materials and methods: Data for hospitalized patients was obtained from the National Inpatient Sample database 2016–2020. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total hospital charges, toxic megacolon, acute kidney injury (AKI), hypovolemic shock, septic shock, need for total parenteral nutrition, cardiac arrest, need for blood transfusion and need for intensive care unit (ICU)-level care. Univariate and multivariate analyses were conducted using SPSS. Results: Among patients with IBD, 4.3% developed CDI compared to 0.9% in the non-IBD population. Overall, IBD was independently associated with a lower risk of in-hospital mortality, AKI, hypovolemic shock, septic shock, cardiac arrest, need for blood transfusions and need for ICU-level care (p-value < 0.001). IBD was associated with a higher risk of requiring total parenteral nutrition (TPN). Sub-group analysis among patients with IBD revealed 6.4% of patients with ulcerative colitis (UC) developed CDI compared to 2.9% of patients with Crohn’s disease (CD). CD was independently associated with a lower risk of in-hospital mortality, hypovolemic shock, septic shock, need for blood transfusions, and need for vasopressors (p-value < 0.001). Conclusions: Hospitalized patients with IBD and CDI had lower in-hospital mortality despite a higher risk of developing CDI, possibly reflecting earlier diagnosis, closer monitoring, and timely treatment. Mortality predictors are important to recognize and accordingly tailor medical decision-making for patient-targeted therapies. This highlights the need for focused efforts targeting early detection of CDI, as well as timely management to prevent complications and mortality.