BACKGROUND Data on the current estimates of the disease burden of Clostridioides difficile (C. difficile) infection in the setting of end-stage liver disease (ESLD) are emerging. AIMS We examined the recent trends and predictors of hospitalizations and in-hospital mortality from C. difficile infection among hospitalizations with ESLD in the USA. METHODS We performed a retrospective analysis using the National Inpatient Sample, 2005-2014. We defined ESLD and C. difficile infection using the International Classification of Diseases, Ninth Revision, Clinical Modification. Multivariable logistic regression was used to determine the risk factors that impacted hospitalization and mortality. RESULTS The prevalence of coding for C. difficile infection in decompensated cirrhosis increased from 1.3% in 2005 to 2.7% in 2014, with an annual rate of 7.8%. In hospitalizations with hepatocellular carcinoma, C. difficile infection increased steadily from 1.0 to 1.7% with an annual incremental rate of 6.4%. Among hospitalizations with ESLD, each passing 2-year period, increasing age, female, higher Charlson index, accompanying infection, hepatorenal syndrome, and ascites were associated with C. difficile infection. Although C. difficile infection was an independent predictor of in-hospital mortality during hospitalization with decompensated cirrhosis (odds ratio 1.53, 95% confidence interval 1.44-1.63), the proportion of in-hospital mortality during hospitalization with C. difficile infection and decompensated cirrhosis decreased from 15.4% in 2005 to 11.1% in 2014, with an annual rate of - 3.1% (95% CI - 5.7% to - 0.3%). CONCLUSIONS While the prevalence of C. difficile infection in hospitalized patients with ESLD increased approximately twofold, the in-hospital mortality decreased significantly during the past decade.

中文翻译：

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终末期肝病中难辨梭状芽胞杆菌感染的住院治疗趋势，2005-2014年。

背景技术关于在终末期肝病（ESLD）的情况下艰难梭菌（C. difficile）感染的疾病负担的当前估计的数据正在出现。目的我们研究了美国ESLD住院患者中难辨梭状芽胞杆菌感染住院和院内死亡率的近期趋势和预测因素。方法我们使用2005-2014年全国住院患者样本进行了回顾性分析。我们使用国际疾病分类第九次修订版《临床修改》定义了ESLD和艰难梭菌感染。多变量logistic回归用于确定影响住院和死亡率的危险因素。结果失代偿性肝硬化中难辨梭状芽胞杆菌感染的编码率从2005年的1.3％上升到2014年的2.7％，年增长率为7.8％。在肝细胞癌住院治疗中，艰难梭菌感染从1.0稳定增长到1.7％，年增长率为6.4％。在进行ESLD的住院治疗中，每过2年，年龄增加，女性，Charlson指数升高，伴随感染，肝肾综合征和腹水都与艰难梭菌感染相关。尽管艰难梭菌感染是失代偿性肝硬化住院期间院内死亡率的独立预测因子（几率1.53，95％置信区间1.44-1.63），但艰难梭菌感染和失代偿性肝硬化住院期间院内死亡率的比例从2005年的15.4％降至2014年的11.1％，年增长率为-3.1％（95％CI-5.7％至-0.3％）。结论C的流行。