Аңдатпа
Introduction: Clostridium difficile infections (CDI) significantly affect hospitalizations, leading to considerable mortality and morbidity. However, the impact of CDI on non-variceal bleeding remains unexplored as most research focuses on variceal bleeding. This study aims to compare the outcomes of CDI in variceal and non-variceal bleeding cases and investigate if variceal bleeding patients have a higher likelihood of developing CDI. Methods: Retrospective analysis was performed using National Inpatient Sample (NIS) from years 2010 to September 2015. Patients were identified using the primary diagnosis of esophageal variceal bleeding and aggregate of different sources of non-variceal bleeding using ICD-9 codes. Primary outcomes were, all-cause mortality, length of stay, hospitalization charges, development of shock, and need for mechanical ventilation. Statistical analysis was conducted by STATA statistical software and analyses included multivariate logistic regression, negative binomial regression and generalized linear regression models. Results: A weighted number of 225,708 hospitalizations were for variceal bleeding and 1,342,724 for non-variceal bleeding. Among variceal bleeding patients, 1.64% (n = 3,696, 95% CI: 1.52 - 1.76) had concurrent CDI, while among non-variceal bleeding patients, 1.07% (n = 14,390, 95% CI: 1.03 - 1.12) had CDI. Patients with variceal bleeding and CDI had significantly longer hospital stays (14.7 vs. 6.2 days, P< 0.001), higher in-hospital mortality (15.2% vs. 10.0%, P< 0.001), increased rates of shock (24.6% vs. 13.1%, P< 0.001) and mechanical ventilation (32.7% vs. 17.3%, P< 0.001), as well as higher hospitalization charges ($168,275 vs. $68,446, P< 0.001). Similar trends were observed among patients with non-variceal bleeding. Comparatively, patients with concurrent CDI had significantly longer hospital stays (10.6 vs. 4.3 days, P< 0.001), higher in-hospital mortality (5.5% vs. 1.9%, P< 0.001), increased rates of shock (13.1% vs. 5.0%, P< 0.001) and mechanical ventilation (12.0% vs. 3.3%, P< 0.001), as well as higher hospitalization charges ($92,480 vs. $37,553, P< 0.001). When compared with non-variceal bleeding patients, patients with variceal bleeding patients had significantly greater odds of contracting concurrent C. difficile infection (adjusted OR: 1.79; 95% CI: 1.60-1.98, P< 0.001). Conclusion: Concurrent CDI for both variceal and non-variceal bleeding groups leads to worser outcomes. Esophageal variceal group has greater odds of developing CDI.