Charilaou P, et al. - This national propensity-matched study was performed to evaluate the effect of acute kidney injury (AKI) in inpatient mortality of Clostridium Difficile infection (CDI) patients. The researchers found an increased incidence of hospital admissions of patients with CDI and concomitant AKI. However, their inpatient mortality had improved over the study period. Independently of other comorbidities, complications, and hospital characteristics, AKI was found to be a significant contributor to mortality, highlighting the need for early diagnosis and aggressive management in such patients.

Methods

• The researchers performed this retrospective observational study using the National Inpatient Sample (NIS) from years 2003-2012.
• They enrolled all adults with CDI and excluded cases missing data on age, inpatient mortality or gender.
• Using survey-weighted multivariable regression, trends and CDI-related complications as mortality predictors were evaluated.
• In this study, they evaluated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustments.

Results

• The researchers included 2,859,599 patients with CDI.
• Out of them, 896,122 (31.3%) patients had a principal diagnosis of CDI.
• In this study, AKI prevalence was 22%.
• Mortality rate was 8.4%, while among AKI patients was higher (18.2%).
• AKI was correlated with higher mortality (OR=3.16, 95%CI: 3.02–3.30; p < 0.001), while after propensity-matching, AKI increased mortality by 86% (OR=1.86, 95%CI: 1.79-1.94; p < 0.001), in multivariable regression.
• Together with the rate of AKI (12.6% in 2003 to 28.8% in 2012; p-trend < 0.001), CDI incidence increased by 1.8.
• Mortality over the study period decreased to 7.2% (2012) from 9.0% (2003); p-trend < 0.001, despite increasing hospitalizations.