Clostridioides difficile infection increases in-hospital mortality, length of stay, and hospital cost but not 30-day mortality in cirrhotic patients

Abstract

Background and Aim: Clostridioides difficile infection (CDI) is a leading cause of nosocomial infection and is associated with both higher morbidity and mortality. Cirrhotic patients are more susceptible to CDI because of impaired gut immune response, use of proton pump inhibitor, and frequent hospitalization. We aim to investigate the impact of CDI on cirrhotic patients' in-hospital and 30-day mortality, length of stay, and hospital cost. Methods: Potentially eligible studies were identified from Embase, Medline, and Web of Sciences databases. Results: A total of 2320 articles were identified. After reviewing, nine studies reporting in-hospital mortality and three reporting 30-day mortality of cirrhotic patients with CDI versus those without CDI were included. The meta-analysis of nine studies, consisting of 7 746 126 patients, revealed a significant association between CDI and in-hospital mortality in cirrhotic patients with the pooled OR of 1.68 (95% CI 1.29–1.85, I2 94%). Length of stay and hospital cost were also higher in the CDI group (pooled MD of 6.56 days [95% CI 5.75–7.36, I2 94%] and 27.85 (×$1000) [95% CI 10.41–45.29, I2 100%], respectively). The funnel plots for the meta-analysis of the association between CDI and in-hospital mortality, length of stay, and hospitalization cost were not suggestive of publication bias. From three studies consisting of 3694 patients, we found that CDI was not associated with 30-day mortality in cirrhotic patients (pooled OR 1.20, 95% CI 0.75–2.24, I2 74%). Conclusion: CDI is associated with increased in-hospital mortality, length of stay, and hospital costs, but not with 30-day mortality in cirrhotic patients.