Investigation of the short- and long-term health outcomes among a national cohort of veterans with and without Clostridioides difficile infection
Creators: name: Zeidan, Amina Rida Abdul Latif
name: 0000-0002-2161-1068
Publisher: name: The University of Texas at Austin
Year: 2021
Subjects: Clostridioides difficile
Veterans health care
Aging
Frailty

description: Clostridioides difficile infection (CDI) is an urgent public health problem in the United States (U.S.). C. difficile is now the most common organism implicated in healthcare-associated infections and the main source of antibiotic-associated diarrhea. Nearly half a million Americans suffer from and 29,000 die as a result of CDI annually. Importantly, CDI disproportionately affects the elderly population, with 70% of cases occurring in patients older than 65. CDI places a significant burden on patients in the short-term. While CDI commonly manifests as diarrhea, it can lead to more severe manifestations like megacolon, intestinal perforation, sepsis, or death. Importantly, CDI has been associated with impaired functional capacity in the short-term and poor overall quality of life, including physical, mental, and social functioning. CDI has also been associated with prolonged gut microbiome dysbiosis. Dysbiosis has been previously associated with may aging- and frailty-associated conditions due to a strong biological link with the gut microbiome. Despite robust, short-term epidemiological studies, the long-term impact of CDI on healthy aging has not been investigated. To inform this knowledge gap, we addressed the hypothesis that CDI negatively affects long-term healthspan and lifespan. Our study aimed to define short- and long-term health outcomes of patients with and without CDI among a national cohort of veterans. This was a retrospective cohort study of adult patients presenting to any outpatient or inpatient Veterans Health Administration facility in the United States from October 1, 2002 to September 30, 2018. CDI patients were defined as those with an ICD-9-CM or ICD-10 code for CDI plus a positive C. difficile stool test and active CDI therapy. A control group was created by identifying non-CDI patients and matching 2:1 based on inpatient/outpatient visit and fiscal year. The outcomes of this study included 1 month, 3 month, 12 month, and 10-year aging-related conditions, frailty-associated conditions, and mortality. The association between CDI and these outcomes was assessed using a series of propensity score matched cohorts (1 CDI:1 control) and adjustment for covariates post-match using multivariable logistic regression. A total of 31,531 CDI cases and 81,293 non-CDI matched controls were included for analysis. CDI was significantly associated with risk for mortality at 1 month (OR 3.75, 99% CI 3.23-4.34), 3 months (OR 3.07, 99% CI 2.74-3.43), 12 months (OR 2.70, 99% CI 2.47-2.96), and 10 years (OR 1.62, 99% CI 1.34-1.97). Though numerically higher among CDI patients, the risk for chronic aging-related conditions was not statistically significant at any follow-up period, and there was no significant association between the number of CDI episodes and the development of aging related conditions. CDI patients had higher prevalence of any frailty-related condition at short-term follow-up periods and CDI was significantly associated with the development of frailty-associated conditions at 12 months (OR 1.27, 99% CI 1.15-1.41). Finally, the number of CDI episodes was positively and significantly associated with VA frailty index at 12 months and 10 years (p&lt;0.0001). In summary, CDI was associated with poor short- and long-term outcomes compared to a matched control group among a national cohort of veterans. This work is innovative because it utilizes robust data analytics on one of the world’s largest clinical cohorts of CDI patients. This research is expected to have a positive impact on human health by promoting appropriate CDI prevention and treatment.