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Harish Patel,1,2 Jasbir Makker,1,2 Trupti Vakde,1,3 Danial Shaikh,1,2 Kanthi Badipatla,1,2 James Dunne,4 Nikhitha Mantri,1 Suresh Kumar Nayudu,1,2 Mariela Glandt,1 Bhavna Balar,1,2 Sridhar Chilimuri1,2 1Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 2Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 3Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 4Support Service and Operation, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USACorrespondence: Jasbir MakkerBronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Selwyn Ave, Bronx, NY, USATel +1 7185181234Email jmakker@bronxleb.orgPurpose: Mouse model experiments have demonstrated an increased Clostridium difficile infection (CDI) severity with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) use. We aim to evaluate the impact of NSAIDs in humans after a diagnosis of CDI on primary outcomes defined as I) all-cause mortality and II) toxic mega-colon attributable to CDI.Patients and methods: All hospitalized patients with a diagnosis of CDI were divided into two groups; those with NSAIDs administered up to 10 days after onset of CDI versus no NSAIDs use. The primary outcomes were analyzed between the groups, while controlling for severity of CDI. A logistic regression analysis was performed to identify the predictors of worse outcomes.Results: NSAIDs were administered in 14% (n=80) of the 568 hospitalized visits for an average of 2.5 days after the CDI diagnosis. All-cause mortality was high in patients who did not receive NSAIDs as compared to those who did receive NSAIDs (16.6% vs 12.5%, p 0.354). Patients who were prescribed NSAIDs were more likely to have toxic mega-colon as compared to those who were not prescribed NSAIDs (2.5% vs 0.6%, p 0.094). Results were not statistically significant, even after controlling for CDI severity. Logistic regression analysis did not identify NSAIDs administration as a significant factor for all-cause mortality in CDI patients.Conclusion: This retrospective study results, contrary to mouse model, did not show association between NSAID use and CDI related mortality and toxic mega-colon. Shorter duration of NSAIDs use, younger people in study group, and timely CDI treatment may have resulted in contrasting results.Keywords: colitis, NSAIDs, Clostridium difficile infection, nonsteroidal anti-inflammatory drugs, toxic megacolon

Nikhitha Mantri,1 Harish Patel,1,2 Kanthi Rekha Badipatla,1,2 Haozhe Sun,1 Danial Shaikh,1,2 Sudharsan Gongati,1 Suresh Kumar Nayudu1,2 1Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 2Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USACorrespondence: Suresh Kumar NayuduBronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Selwyn Ave, Bronx, NY, USATel +1 2122035476Fax +1 7189602055Email SNAYUDU@bronxleb.orgPurpose: Clostridioides difficile infection (CDI) is one of the most common health care-associated infections in the United States. Studies revealed a higher mortality when CDI is associated with liver cirrhosis. We aim to present the outcomes of CDI among patients with and without liver cirrhosis and to analyze the association of Model for End-Stage Liver Disease (MELD) and Child-Pugh (CPT) scoring with the severity of CDI.Methods: A retrospective observational study was conducted in hospitalized patients with CDI diagnosed via a 2-step method – glutamate dehydrogenase (GDH) and toxin polymerase chain reaction (PCR). Patients with liver cirrhosis were identified based on ICD codes and chart review. MELD and CPT scores were calculated using laboratory parameters at the time of hospitalization. We compared CDI-related mortality in patients with and without cirrhosis and reviewed the CDI severity distribution in cirrhosis patients.Results: A total of 526 patients were included in the study, of which 478 (90.87%) were non-cirrhotic and 48 (9.13%) were cirrhotic patients. Mortality rate was higher in cirrhosis group compared to the non-cirrhosis group (39.6% vs. 14.6%,P = 0.001). Among cirrhosis patients, those who survived had lower MELD score compared to the expired group (14.9 vs. 18.58, P = 0.106). There was no correlation of mortality based on CPT score in the cirrhosis group (P = 0.062). In post hoc analysis comparing the severity of CDI to liver cirrhosis, cirrhosis patients are more likely to present with severe-complicated disease. Multivariate logistic regression identified liver cirrhosis, severe-complicated CDI and serum albumin level as independent predictors of mortality.Conclusion: Our study noted a more severe disease presentation and higher mortality in patients with cirrhosis admitted with CDI. Further studies are required for better understanding of the clinical course of CDI in cirrhosis and to evaluate the need for early intervention in this patient group.Keywords: clostridioides difficile infection; CDI, cirrhosis, mortality, severity, Model for End-Stage Liver Disease; MELD, Child-Pugh; CPT