Jiang Y, Chowdhury S, Xu BH, Meybodi MA, Damiris K, Devalaraju S, Pyrsopoulos N. Nonalcoholic fatty liver disease is associated with worse intestinal complications in patients hospitalized for Clostridioides difficile infection. World J Hepatol 2021; 13(11): 1777-1790 [PMID: 34904045 DOI: 10.4254/wjh.v13.i11.1777]
Corresponding Author of This Article
Nikolaos Pyrsopoulos, FAASLD, AGAF, FACG, MD, PhD, Director, Professor, Department of Medicine, Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 S. Orange Avenue, Medical Science Building H-536, Newark, NJ 07101, United States. pyrsopni@njms.rutgers.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yi Jiang, Salil Chowdhury, Mohamad Aghaie Meybodi, Konstantinos Damiris, Samanthika Devalaraju, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07101, United States
Bing-Hong Xu, Liver Center and Center for Asian Health, RWJBH-Saint Barnabas Medical Center, Florham Park, NJ 07932, United States
Nikolaos Pyrsopoulos, Department of Medicine, Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07101, United States
Author contributions: Jiang Y and Pyrsopoulos N planned and designed the study; Chowdhury S, Xu BH, Meybodi MA, Damiris K and Devalaraju S conducted the data collection and interpretation; Jiang Y, Chowdhury S, Xu BH, Damiris K and Devalaraju S contributed to the manuscript preparation; All authors contributed to the manuscript revisions, reviewed, and approved the final submitted manuscript.
Institutional review board statement: This retrospective cohort study did not directly involve any patients in the data collection process and the National Inpatient Sample (NIS) database is de-identified and available for the public. Therefore, Institutional Review Board approval was not required.
Conflict-of-interest statement: The authors have no conflicts of interest related to this publication.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at pyrsopni@njms.rutgers.edu. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos Pyrsopoulos, FAASLD, AGAF, FACG, MD, PhD, Director, Professor, Department of Medicine, Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 S. Orange Avenue, Medical Science Building H-536, Newark, NJ 07101, United States. pyrsopni@njms.rutgers.edu
Received: June 14, 2021 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 Processing time: 162 Days and 16.3 Hours
ARTICLE HIGHLIGHTS
Research background
The ongoing exploration of liver-gut axis has discovered strong association between gut dysbiosis and nonalcoholic fatty liver disease (NAFLD) in both basic science and clinical research. Small-scaled studies have observed that NAFLD is an independent risk factor for Clostridioides difficile infection (CDI).
Research motivation
CDI, as the most common cause of nosocomial diarrhea in developed countries, carries high hospitalization burden. NAFLD, as the leading cause of chronic liver disease, is commonly seen in hospitalized patients with CDI. So far the inpatient outcomes of CDI in the NAFLD population have not been well studied.
Research objectives
The authors aimed to examine the impact of NAFLD on the inpatient outcomes of hospitalized patients with CDI, by comparing the effect of NAFLD with alcoholic liver disease (ALD) and viral liver disease (VLD) individually.
Research methods
This nationwide retrospective cohort study was conducted according to STROBE statement using the National Inpatient Sample database. Inpatient CDI with coexisting NAFLD cases were selected using ICD-9 codes. Multivariate regression analysis was used with adjustment for a large group of possible confounders. Elixhauser Comorbidity Index (ECI) was used for a full description of comorbidity burden.
Research results
CDI with NAFLD was independently associated with lower rates of acute respiratory failure, shorter length of stay and lower hospitalization charges when compared to CDI with VLD and CDI with ALD. However, CDI with NAFLD was associated with a higher rate of intestinal perforation when compared to VLD, and a higher rate of intestinal obstruction when compared to ALD.
Research conclusions
CDI and coexisting NAFLD is associated with favorable overall outcomes, but higher rates of intestinal complications compared to CDI with coexisting ALD and VLD, individually.
Research perspectives
This finding suggests that alteration of gut microbiota may play an important role in the pathogenesis of both CDI and NAFLD. NAFLD associated metabolic syndrome may contribute significantly to the gut dysbiosis and cause increased risk for CDI and its complications. This study provides potential directions for future prospective clinical research to identify the clinical meaningfulness of interactions between gut microbiota, gut immunity and systemic inflammation. The study may open the door for potential microbiota therapeutic targets and manipulation as future treatment options for chronic liver diseases.
