S1699 Inpatient Outcomes of Clostridioides difficile Infection in Patients With Underlying Inflammatory Bowel Disease

Introduction: Clostridioides difficile infection (CDI) is a common complication in patients with inflammatory bowel disease (IBD). This study aims to evaluate inpatient outcomes in patients with a history of IBD who develop CDI. Methods: We utilized data from the National Inpatient Sample (NIS) database from 2016 to 2021 to identify adult patients (>18 years) with a primary diagnosis of IBD and a secondary diagnosis of CDI, using International Classification of Diseases-10 codes K50, K51 and A04.7 and Patients were stratified into 2 cohorts: those with CDI and those without. Multivariable logistic regression model was used to assess the association between CDI and primary outcomes of in-hospital mortality, ICU admission and colectomy. Data was split into a training set (2016-2019) to fit the model and a testing set (2020-2021) to evaluate the model. Results: There were a total of 382,498 patients with IBD included in this study, out of which 15,822 patients were diagnosed with CDI. Patients with IBD and CDI were older on average (55.3 vs 54.3 years, P < 0.001) and more likely to be malnourished (26.9% vs 14.5%, P < 0.001). They also had higher rates of mortality (3.5% vs 1.7%, P < 0.001), acute kidney injury (AKI) (23.6% vs 16.8%, P < 0.001), shock (8.6% vs 3.5%, P < 0.001), and intensive care unit (ICU) admission (5.0% vs 3.0%, P < 0.001). However, on multivariable analysis with adjustment for confounders, we found that IBD and CDI patients had lower odds of ICU admission (OR 0.84, 95% CI: 0.77–0.92, P < 0.001) and colectomy (OR 0.49, 95% CI: 0.44–0.54, P < 0.001) compared to IBD patients without CDI. There was no difference in mortality between the 2 groups (OR 1.07, 95% CI: 0.97–1.20, P = 0.15). These trends remained the same on subgroup analyses for ulcerative colitis (UC) and Crohn’s disease except for the outcome of ICU admission which was only significant for the UC group. Conclusion: IBD patients with CDI exhibit higher crude rates of mortality, AKI, shock, ICU admissions, suggesting more severe disease activity. However, after adjusting for confounders, CDI was not independently associated with increased mortality, and was linked to lower odds of ICU admission and colectomy, these finding highlight the importance of early detection and management of CDI in IBD patients, especially if malnourished. Further research is needed to better understand the factors influencing outcomes and to develop targeted strategies to mitigate complications in this vulnerable population.