S2056 Impact of Protein-Calorie Malnutrition on 1-Year Cardiovascular and Thromboembolic Outcomes in Patients With Clostridioides difficile Infection: A Retrospective Cohort Study

Introduction: Malnutrition has significant health implications, contributing to increased morbidity, mortality, and prolonged hospitalizations in patients. Its impact in patients with Clostridioides difficile infection (CDI) has not been thoroughly evaluated. In this study, we aim to examine the relationship between PCM and once-year cardiovascular and thromboembolic outcomes in patients with CDI within the United States. Methods: We conducted a retrospective analysis of deidentified, aggregate patient data from TriNetX research network. The cohort compromised patients 18 years of age or older with a diagnosis of CDI. Within this cohort, patients with and without PCM were identified. Primary outcomes were 1-year cardiovascular and thromboembolic events, including pulmonary embolism (PE), deep vein thrombosis (DVT), atrial fibrillation (AF), ventricular fibrillation (VF), ventricular tachycardia (VT), myocardial infarction (MI), heart failure exacerbation, stroke, and cardiac arrest. Variables including age, sex, comorbidities, and other factors known to confound the association between PCM and the composite outcomes underwent 1:1 propensity score matching. Cox proportional hazards regression analysis was also utilized to analyze the matched cohorts. Results: Patients with PCM exhibited significantly higher odds of adverse cardiovascular outcomes compared to those without malnutrition. The odds of developing PE were 1.49 times higher (odds ratio [OR]: 1.485, 95% confidence interval [CI]: 1.323-1.666, P < 0.001), and the odds of DVT were markedly elevated as well (OR: 1.91, 95% CI: 1.778-2.047, P < 0.001). Additionally, malnourished patients had a slightly increased risk of AF (OR: 1.12, 95% CI: 1.023-1.219, P = 0.013) and a 34% higher risk of VF (OR: 1.34, 95% CI: 1.000-1.794, P = 0.049). The odds of VT were also significantly higher in this group (OR: 1.35, 95% CI: 1.184-1.529, P < 0.001). The risk of acute MI was increased (OR: 1.29, 95% CI: 1.169-1.415, P < 0.001), as was the risk of HF exacerbation (OR: 1.32, 95% CI: 1.218-1.425, P < 0.001). Stroke risk was similarly elevated (OR: 1.29, 95% CI: 1.156-1.427, P < 0.001), and the odds of cardiac arrest were significantly higher in malnourished patients (OR: 1.36, 95% CI: 1.217-1.522, P < 0.001). Conclusion: PCM significantly worsens 1-year cardiovascular and thromboembolic outcomes in patients with CDI. These findings underscore the need for targeted nutritional interventions and close monitoring of high-risk patients with PCM to mitigate adverse outcomes.