Trends in Hospitalizations for Clostridioides difficile Infection in End-Stage Liver Disease, 2005–2014



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.


We examined the recent trends and predictors of hospitalizations and in-hospital mortality from C. difficile infection among hospitalizations with ESLD in the USA.


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.


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%).


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.

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Fig. 1



End-stage liver disease


Hepatocellular carcinoma


National Inpatient Sample


International Classification of Diseases, 9th Revision Clinical Modification


Nonalcoholic fatty liver disease


Annual percentage change


Confidence interval


Odds ratio


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Author information




DK developed the study concept and design and was involved in acquisition, analysis, and interpretation of data. He developed the manuscript outline, obtained input from co-authors and drafted the manuscript. ERY, AAL, SPT, and GC were involved in interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. AA was involved in developing the study concept and design, analysis, and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision.

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Correspondence to Donghee Kim.

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Kim, D., Yoo, E.R., Li, A.A. et al. Trends in Hospitalizations for Clostridioides difficile Infection in End-Stage Liver Disease, 2005–2014. Dig Dis Sci 66, 296–307 (2021).

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  • Cirrhosis
  • National Inpatient Sample
  • Infection
  • Mortality