Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1777
Peer-review started: June 14, 2021
First decision: July 27, 2021
Revised: August 8, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 27, 2021
The ongoing exploration of liver-gut axis has discovered strong association between gut dysbiosis and nonalcoholic fatty liver disease (NAFLD) in both basic science and clinical research. Small-scaled studies have observed that NAFLD is an independent risk factor for Clostridioides difficile infection (CDI).
CDI, as the most common cause of nosocomial diarrhea in developed countries, carries high hospitalization burden. NAFLD, as the leading cause of chronic liver disease, is commonly seen in hospitalized patients with CDI. So far the inpatient outcomes of CDI in the NAFLD population have not been well studied.
The authors aimed to examine the impact of NAFLD on the inpatient outcomes of hospitalized patients with CDI, by comparing the effect of NAFLD with alcoholic liver disease (ALD) and viral liver disease (VLD) individually.
This nationwide retrospective cohort study was conducted according to STROBE statement using the National Inpatient Sample database. Inpatient CDI with coexisting NAFLD cases were selected using ICD-9 codes. Multivariate regression analysis was used with adjustment for a large group of possible confounders. Elixhauser Comorbidity Index (ECI) was used for a full description of comorbidity burden.
CDI with NAFLD was independently associated with lower rates of acute respiratory failure, shorter length of stay and lower hospitalization charges when compared to CDI with VLD and CDI with ALD. However, CDI with NAFLD was associated with a higher rate of intestinal perforation when compared to VLD, and a higher rate of intestinal obstruction when compared to ALD.
CDI and coexisting NAFLD is associated with favorable overall outcomes, but higher rates of intestinal complications compared to CDI with coexisting ALD and VLD, individually.
This finding suggests that alteration of gut microbiota may play an important role in the pathogenesis of both CDI and NAFLD. NAFLD associated metabolic syndrome may contribute significantly to the gut dysbiosis and cause increased risk for CDI and its complications. This study provides potential directions for future prospective clinical research to identify the clinical meaningfulness of interactions between gut microbiota, gut immunity and systemic inflammation. The study may open the door for potential microbiota therapeutic targets and manipulation as future treatment options for chronic liver diseases.