Sahra S, Abureesh M, Amarnath S, Alkhayyat M, Badran R, Jahangir A, Gumaste V. Clostridioides difficile infection in liver cirrhosis patients: A population-based study in United States. World J Hepatol 2021; 13(8): 926-938 [PMID: 34552699 DOI: 10.4254/wjh.v13.i8.926]
Corresponding Author of This Article
Syeda Sahra, MD, Doctor, Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, United States. ssahra@northwell.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/
World J Hepatol. Aug 27, 2021; 13(8): 926-938 Published online Aug 27, 2021. doi: 10.4254/wjh.v13.i8.926
Clostridioides difficile infection in liver cirrhosis patients: A population-based study in United States
Syeda Sahra, Mohammad Abureesh, Shivantha Amarnath, Motasem Alkhayyat, Rawan Badran, Abdullah Jahangir, Vivek Gumaste
Syeda Sahra, Mohammad Abureesh, Shivantha Amarnath, Rawan Badran, Abdullah Jahangir, Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 10305, United States
Motasem Alkhayyat, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Vivek Gumaste, Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY 10305, United States
Author contributions: Sahra S, Jahangir A, and Badran R contributed to writing the manuscript; Data extraction and results were drawn by Abureesh M, and Alkhayyat M. Proof reading and supervision was done by Alkhayyat M, Amarnath S, and Gumaste V.
Institutional review board statement: Study protocol was reviewed with Research Department. It was deemed as a population-based study with no patient identifiers and did not need IRB approval.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors report no conflicts of interests (personal or financial).
Data sharing statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request
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: Syeda Sahra, MD, Doctor, Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, United States. ssahra@northwell.edu
Received: May 8, 2021 Peer-review started: May 8, 2021 First decision: June 7, 2021 Revised: June 11, 2021 Accepted: July 22, 2021 Article in press: July 22, 2021 Published online: August 27, 2021 Processing time: 104 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background
Clostridium difficile (C. difficile) is one of the major causes of nosocomial diarrhea and associated morbidity and mortality. The risk factors of C. difficile are historically established. Cirrhosis is a major disease burden in the United States health care system. The risk of morbidity and mortality is higher in cirrhotic patients who acquire C. difficile infection.
Research motivation
This research was motivated by the lack of recent large population study describing the risk factors of C. difficile in liver cirrhotic patients. We also wanted to study the association in patient cohorts who underwent liver transplant as it was not done previously with such higher sample size.
Research objectives
To determine the prevalence of C. difficile infection in patients with liver cirrhosis and to establish the risk factors of C. difficile infection in patients with liver cirrhosis with special emphasis on liver transplantation cohort.
Research methods
The authors used the Explorys database to obtain data that was classified using SNOMED diagnostic codes. Prevalence and association were calculated using multi-variate regression and SPS Software. Details are in the main manuscript.
Research results
The prevalence of C. difficile infection (CDI) amongst the liver cirrhosis population was 134.93 per 100.000 vs 19.06 per 100.000 in non-cirrhotic patients. The multivariate analysis model showed that cirrhotic patients were more likely to develop CDI.
Research conclusions
This research study concluded that cirrhotic patients have a significantly higher CDI prevalence, and liver cirrhosis may be an independent risk factor for CDI.
Research perspectives
There is a possibility of reducing the CDI mortality in cirrhotic patients by screening them for CDI. Future prospective studies are needed in this regard.
