The development of Clostridioides difficile Infection is associated with the severity of liver disease and worsens survival in acutely decompensated cirrhosis.

Clostridioides difficile infection (CDI) frequently occurs in advanced cirrhosis. We aimed to evaluate risk factors for CDI in acutely decompensated cirrhosis and its impact in relevant clinical outcomes

METHODS

The study included patients with cirrhosis that were consecutively admitted for acute decompensation in a tertiary care hospital during a CDI outbreak. Data on admission, CDI ribotype, length of hospital stay, and 12-week survival were compared between patients with and without CDI.

RESULTS

Twenty-nine out of 117 (24.7%). admitted patients developed CDI during hospitalization. Ribotype 027 was identified in 17 patients (58.6% of CDI cases). Patients with CDI had significantly worse baseline liver function, with higher MELD-sodium [19vs.14; p=0.002) and CLIF-C scores [56.6 vs. 52.0 p=0.04)] and were more frequently exposed to antibiotic therapy. Independent predictors of CDI included higher MELD-Na score [OR:1.13; p=0.002] and previous recent antibiotic use [OR: 4.93; p=0.001]. CDI was associated with a longer hospital stay [34 days (IQR 10-41) vs. 9 days (IQR 5-18); p=0.0001]. Although in-hospital mortality was similar between groups, age [OR: 1.08; (CI 95 %: 1.03- 1.13); p=0.001], MELD-sodium score [OR: 1.12 (CI 95 %:1.03 - 1.22); p=0.008], and ribotype 027 (OR: 4.25 , (CI 95 %:1.16 - 15.58); p=0.003] were independently associated with 12-week mortality.

CONCLUSION

Severity of liver failure and recent exposure to antibiotics are risk factors for the development of CDI in acutely decompensated cirrhosis. CDI significantly increases 12-week mortality particularly in cases with the hypervirulent 027 ribotype strain.