Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1777
Peer-review started: June 14, 2021
First decision: July 27, 2021
Revised: August 8, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 27, 2021
Nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease with increasing prevalence worldwide. Clostridioides difficile infection (CDI) remains the most common cause of nosocomial diarrhea in developed countries.
To assess the impact of NAFLD on the outcomes of hospitalized patients with CDI.
This study was a retrospective cohort study. The Nationwide Inpatient Sample database was used to identify a total of 7239 adults admitted as inpatients with a primary diagnosis of CDI and coexisting NAFLD diagnosis from 2010 to 2014 using ICD-9 codes. Patients with CDI and coexisting NAFLD were compared to those with CDI and coexisting alcoholic liver disease (ALD) and viral liver disease (VLD), individually. Primary outcomes included mortality, length of stay, and total hospitalization charges. Secondary outcomes were in-hospital complications. Multivariate regression was used for outcome analysis after adjusting for possible confounders.
CDI with NAFLD was independently associated with lower rates of acute respiratory failure (2.7% vs 4.2%, P < 0.01; 2.7% vs 4.2%, P < 0.05), shorter length of stay (days) (5.75 ± 0.16 vs 6.77 ± 0.15, P < 0.001; 5.75 ± 0.16 vs 6.84 ± 0.23, P <0.001), and lower hospitalization charges (dollars) (38150.34 ± 1757.01 vs 46326.72 ± 1809.82, P < 0.001; 38150.34 ± 1757.01 vs 44641.74 ± 1660.66, P < 0.001) when compared to CDI with VLD and CDI with ALD, respectively. CDI with NAFLD was associated with a lower rate of acute kidney injury (13.0% vs 17.2%, P < 0.01), but a higher rate of intestinal perforation (P < 0.01) when compared to VLD. A lower rate of mortality (0.8% vs 2.7%, P < 0.05) but a higher rate of intestinal obstruction (4.6% vs 2.2%, P = 0.001) was also observed when comparing CDI with NAFLD to ALD.
Hospitalized CDI patients with NAFLD had more intestinal complications compared to CDI patients with VLD and ALD. Gut microbiota dysbiosis may contribute to the pathogenesis of intestinal complications.
Core Tip: This study demonstrated that patients hospitalized with Clostridioides difficile infection (CDI) and coexisting nonalcoholic fatty liver disease (NAFLD) had more favorable overall outcomes but higher rates of intestinal complications when compared to those with alcoholic liver disease and viral liver disease individually, which suggests altering gut microbiota may play an essential role in the pathogenesis of both CDI and NAFLD. NAFLD-associated metabolic syndrome may contribute significantly to gut dysbiosis and increase risk for CDI and its complications. This study provides potential directions for future prospective clinical research to identify the clinical meaningfulness of interactions between the gut microbiota, gut immunity and systemic inflammation.