Sarcopenia and frailty contribute to adverse clinical outcomes in patients with cirrhosis awaiting and after liver transplantation (LT). However, the impact of sarcopenia/physical frailty on perioperative LT outcomes has not been reported. The effect of physical frailty and sarcopenia on hospitalization outcomes in patients undergoing liver transplantation was evaluated in a nationwide dataset. Adult patients undergoing liver transplantation from 2016 to 2020 in the National Inpatient Sample database without/with frailty (defined by the hospital frailty risk score) and/or sarcopenia (defined by muscle-loss phenotype) were analyzed. Patients were stratified into those without sarcopenia or frailty (sarcopenia/frailty), with either sarcopenia/frailty, and those with both sarcopenia and frailty. Univariate and multivariate logistic/linear regression analyses were performed to compare in-hospital mortality, perioperative organ system complications, length of stay, and costs during the LT hospitalization in patients without/with frailty and/or sarcopenia. Adjustments were made for patient demographics, hospital characteristics, modified Charlson comorbidity index, etiology, and decompensation of liver disease. Among the 34,405 LT recipients, there was a high prevalence of frailty alone (35

Objectives The study aimed to compare the risk of gastrointestinal infections among patients with and without metabolic dysfunction-associated fatty liver disease (MAFLD).Methods This was a population-based, retrospective, observational study using data from the National Inpatient Sample (NIS), the largest all-payer US inpatient care database.Setting Hospitalisation of adults aged ≥18 years old admitted in 2020 was identified using the NIS. Patients were stratified by the presence and absence of MAFLD.Participants 26.4 million adults aged ≥18 years old were included in the study. Patients younger than 18 and those with missing demographic or mortality data were excluded.Primary and secondary outcomes Primary outcome was to assess the overall risk of gastrointestinal infections in patients with and without MAFLD. Secondary outcomes were demographics and comorbidities stratified by the presence or absence of gastrointestinal infection, and the risk of specific gastrointestinal pathogens.Results Of 26.4 million patients admitted in 2020, 755 910 (2.85%) had the presence of MAFLD. There was a higher prevalence of bacterial gastrointestinal infections in patients with MAFLD than those without (1.6% vs 0.9%, p<0.001). The incidence of Clostridioides difficile (1.3% vs 0.8%, p<0.001), Escherichia coli (0.3% vs 0.01%, p<0.001), and Salmonella (0.07% vs 0.03%, p<0.001) was higher in patients with MAFLD. The presence of MAFLD was associated with higher odds of developing gastrointestinal infections (adjusted OR (aOR) −1.75, 95% CI −1.68 to 1.83, p<0.001). After adjusting for confounders, results remained statistically significant (aOR −1.36, 95% CI - 1.30-1.42, p<0.001).Conclusion Even after adjusting for confounding factors, our study demonstrates an increased risk of gastrointestinal infections in patients with MAFLD, specifically of C. difficile, E. coli, and Salmonella. The immune and microbiota changes seen within MAFLD potentially contribute to the increased risk of gastrointestinal infections.

Background and Aims: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory condition. Associated pathologies for EoE are similar to those with metabolic-dysfunction-associated steatotic liver disease (MASLD). This study assesses whether an association exists between MASLD and EoE. Methods: We used National Inpatient Sample (NIS) 2020 data to identify adult patients. ICD-10 codes were used to identify patients with MASLD and EoE. The relationship between MASLD and EoE was assessed by multivariate analysis after adjusting for confounding factors, such as patient demographics, hospital characteristics, Charlson comorbidity index, obesity, obstructive sleep apnea (OSA), diabetes, hypertension (HTN), hyperlipidemia (HLD), inflammatory bowel disease (IBD), celiac disease (CD), gastroesophageal reflux disease (GERD), smoking, alcohol use, and irritable bowel syndrome (IBS). Results: Out of 26 million patients, 4,820 had a diagnosis of EoE. The majority of the patients were between 18 and 44 years of age (47.82%), male (54.05%), had private insurance (50.1%), and were in the highest income quartile (29.25%). A higher incidence of MASLD was noted in the EoE group than those without (6.1% vs.2.9%, p<0.001). After adjusting for confounding factors, MASLD had 2.38 times higher odds of having EoE (95% CI-1.82-3.11, p<0.001). Other factors noted to be associated with higher odds of EoE included younger age, Caucasian race, IBS, GERD, IBD, and CD. Conclusions: Our study reports a novel finding that MASLD and EoE are associated. Future prospective studies are needed to confirm and understand the clinical significance of this relationship and how one disease affects the other.

Background: Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality among hospitalized patients, particularly those who are immunosuppressed. We aim to assess the outcomes of CDI among kidney transplant (KT) recipients. Methods: Nationwide Inpatient Sample from 2016 to 2020 was used to identify patients with KT and stratify based on the presence of CDI. Data were collected regarding demographics and comorbidities. Outcomes included in-hospital mortality, acute kidney injury, intensive care unit admission, transplant rejection, transplant failure, length of stay, and total hospitalization charges. The relationships between variables of interest and outcomes were analyzed using multivariate regression. Results: A total of 557,635 KT recipients were included. CDI prevalence was 2.4%. The majority of patients in the CDI group were age > 65 (43.6%), female (51%), White (55.3%), and had Medicare insurance (74.9%). On multivariate regression analysis, CDI was associated with increased odds of acute kidney injury (aOR 2.06, p < 0.001), intensive care unit admission (aOR 2.47, p < 0.001), and mortality (aOR 1.90, p < 0.001). CDI was also associated with longer length of stay (9.35 days vs 5.42 days, p < 0.001) and higher total hospitalization charges ($110,063 vs $100,006, p < 0.001). There was no difference in transplant rejection, complication, failure, or infection among KT recipients with CDI and those without. Conclusions: We found that CDI was associated with worse outcomes and higher costs. KT patients should be monitored closely for signs of CDI in order to initiate appropriate management. (c) 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Summary Despite advancing treatment methods, esophageal cancer (EC) maintains a high mortality rate and poor prognosis. Through various mechanisms, aspirin has been suggested to have a chemopreventive effect on EC. However, the long-term impact, particularly regarding the rate of metastasis, needs to be further elucidated. NIS 2016–2020 was used to identify adult patients (age > 18 years) with EC using ICD-10 codes. Patients with missing demographics and mortality were excluded. Patients were stratified into two groups based on aspirin use. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and comorbidities (hypertension, chronic pulmonary disease, coronary artery disease (CAD), chronic kidney disease (CKD), congestive heart failure (CHF), coagulopathy, alcohol use, smoking, and obesity). The outcomes studied were rates of total metastasis, gastrointestinal (GI) metastasis, non-GI metastasis, and lymphoid metastasis. Multivariate logistic regression analysis was performed to evaluate the impact of aspirin use on various metastases after adjusting for patient demographics, comorbidities, and ECI. Out of 190,655 patients, 20,650 (10.8%) patients were aspirin users. Majority of the patients in the aspirin group were aged > 65 years (74.7%), males (82.1%), White race (84%), and had medicare insurance (71%). There was a higher incidence of diabetes, hypertension, chronic pulmonary disease, CAD, CKD, CHF, and smoking in aspirin users than non-aspirin users. Patients with aspirin users had a lower incidence of metastasis (28.9% vs. 38.7%, P < 0.001), GI metastasis (14.2% vs. 20.6%, P < 0.001), non-GI metastasis (15.1% vs. 22%, P < 0.001), and lymphoid metastasis (8.9% vs. 11.3%, P < 0.001) than non-aspirin users. After adjusting for confounding factors, patients with aspirin use had lower odds of having metastasis (aOR-0.73, 95% CI-0.70-0.77, P < 0.001). Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with EC. These studies support the use of aspirin in patients with EC and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with EC.

Introduction: Lymphoplasmacytic sclerosing pancreatitis (LSP), also known as autoimmune pancreatitis, is a rare form of chronic pancreatitis that was histopathologically first described in 1961. Diagnosis remains challenging, with the symptoms and imaging workup resembling pancreatic cancer, and with no consensus diagnostic guidelines. Serological markers such as IgG4 have been proposed, however studies reporting sensitivities as low as 61%. These challenges can delay diagnosis and worsen outcomes. Our patient presented with non-specific symptoms and imaging that preliminarily reflected a pancreatic neoplasm. Subsequent pathology would indicate the presence of IgG4-negative-LSP and the patient would be started on steroids. However due to lack of improvement, surgical intervention was deemed necessary. Case Description/Methods: A middle-aged male presented with 1 month of intermittent epigastric pain, nausea, and weight loss. CT abdomen showed a hypoenhancing soft tissue mass encasing portions of the duodenum, highly suspicious for pancreatic adenocarcinoma. EUS-guided biopsy (Figure 1) indicated a dense lymphoplasmacytic infiltrate without evidence of malignancy. IgG4, CEA, and CA19-9 levels would be below threshold. He was subsequently started on intravenous prednisone 40mg daily for a suspected diagnosis of LSP. Despite therapy, the patient would have worsening symptoms and hemodynamic instability. He would be transferred and subsequently undergo a Whipple procedure with subsequent resolution of symptoms. Discussion: LSP, due to its rare presentation, is often misdiagnosed as pancreatic cancer. Diagnosis remains challenging with no consensus diagnostic criteria. Steroid responsiveness is no longer considered diagnostic, with lack of qualifying data. Elevation of IgG4 can be observed. However there have been reports of histopathologically-confirmed LSP in IgG4 negative patients. As a result, IgG4 alone cannot be used to diagnose LSP. Pathology, therefore remains crucial in diagnosis with cancer being essential to rule out. LSP is generally responsive to steroid therapy, generally requiring 2-to-4 weeks of treatment. There are no consensus guidelines on what defines remission, with experts' opinions including resolution of imaging findings, reduction in symptoms, and improvement in laboratory values. If symptoms do not improve, prior reports indicate that surgical resection is crucial to improve outcomes. We hope to bring greater awareness of LSP as rare cause of abdominal pain in patients with a pancreatic mass.Figure 1.: Pancreatic mass biopsy tissue pathology indicating small intestinal mucosa with well-preserved architecture indicating mixed lymphoplasmacytic infiltrate in the lamina propria with associated mucosal edema.

An isolated hydatid cyst of the spleen is a rare presentation of echinococcal diseases, especially in non-endemic areas where it may end up with unnecessary work-up and misdiagnosis. Here, we present the case of a 28-year-old female presenting with generalized abdominal pain, constipation, and early satiety who had a delayed diagnosis of isolated splenic hydatid cyst which was partially treated with albendazole, eventually requiring splenectomy.

Introduction: Patients with human immunodeficiency virus(HIV) and acquired immunodeficiency syndrome(AIDS) have been increasingly associated with pathology of the liver and biliary tracts. AIDS cholangiopathy is one of the complications associated with the notable immunosuppression seen in HIV and particularly AIDS. Classically seen in patients with CD4 counts less than 100, AIDS cholangiopathy is associated with opportunistic infections causing inflammation and subsequent sclerosing cholangitis. Although not as common in developing nations with the advent of highly active antiretroviral therapy (HAART), AIDS cholangitis can be frequently seen in developing nations and in severely immunosuppressed patients. We describe the case of a 20-year-old man with newly diagnosed AIDS, who presented with diarrhea, weakness, and abdominal pain and was found to have AIDS cholangiopathy and subsequently successfully managed with antiretroviral therapy. Case Description/Methods: Our patient is a 20-year-old man with no significant past medical history who presented endorsing several weeks of intermittent abdominal pain and generalized weakness. Initial labs were notable for a alkaline phosphatase of 1,445, aspartate transaminase of 302, alanine aminotransferase of 238, total bilirubin of 0.6, and lipase of 132. Utrasound indicated biliary duct dilatation. Computed tomography of the abdomen/pelvis indicated bile and pancreatic duct dilatation. Magnetic resonance cholangiopancreatography (MRCP) indicated intra and extrahepatic biliary ductal dilatation and diffuse dilatation of pancreatic duct without choledocholithiasis. Human immunodeficiency virus testing would come back positive with a CD4 count of 36 and hepatitis testing negative. Endoscopic retrograde cholangiopancreatography(ERCP) showed multiple areas of stricturing and dilatation throughout the intrahepatic biliary system, suspicious for inflammatory or infectious cholangitis. The patient would be started on combination antiretroviral medication. The patient would be clinically stabilized and subsequently discharged to home. Repeat labs in 2 weeks indicated improvement in liver function tests (LFTs) (Figure 1). Discussion: AIDS cholangiopathy occurs as a result of opportunistic infections causing inflammation and biliary sclerosis in immunocompromised AIDS patients. Labs typically indicate a cholestatic picture, with imaging often indicating biliary sclerosis and obstruction. Management is aimed at obstruction mitigation and antiretroviral therapy.Figure 1.: Endoscopic retrograde cholangiopancreatography indicating multiple areas of stricturing and dilatation throughout the intrahepatic biliary system.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Studies have reported an association between NAFLD and changes in the gut microbiome. H.pylori infection has also been observed to be a factor in the development of insulin resistance and non-alcoholic fatty liver disease. The current study aims to assess the relationship between the presence of NAFLD and the risk of Helicobacter pylori (HP) infection. Methods: National Inpatient Sample (NIS) database 2020 was used to stratify patients based on the presence of HP infection. Information was collected regarding patient demographics, hospital characteristics, Charlson comorbidity index, coexisting comorbidities (GERD, hyperlipidemia, tobacco use, diabetes, hypertension, obesity, obstructive sleep apnea(OSA), and inflammatory bowel disease (IBD)) as well as HP. Univariate and Multivariate analysis was performed to identify the relationship between NAFLD and HP infections after adjusting for confounding factors. Results: Out of 26 million patients, 24,910 patients had concomitant HP infection. The majority of the patients in the HP infection group were aged >65 years (46.1%), female (45.4%), had Medicare (41.9%) and were in the lowest income quartile (38.6%). There was a higher prevalence of NAFLD in patients with HP infection than those without (5.9% vs 2.9%, P< 0.001). There was a higher incidence of GERD, diabetes, and hypertension in the HPI group than those without (Table 1). After adjusting for confounding factors, the relationship between NAFLD and HP infection was noted to be statistically significant (aOR-1.58, 95% CI-1.41-1.79, P< 0.001). Other factors noted to be associated with HP infection included IBD, celiac disease, male gender, racial factors, and IBS. Diabetes, OSA, and obesity were noted to be associated with a reduced risk of HP infection (Figure 1). Conclusion: Our study demonstrated a notable increase in the risk of HP infections in patients with NAFLD. Since the data is cross-sectional, it is difficult to ascertain if HP infection is the cause or effect of NAFLD. Previous studies have noted a bidirectional relationship. Our study builds up on the previous data, and it is likely that these patients have microbiome alterations predisposing them to developing HP infections. Further prospective studies are needed to identify the causal relationship between these 2 conditions.Figure 1.: Results of multivariant logistic regression analyzing the association between H. Pylori and study variables. Table 1. - Patient characteristics and comorbidities, stratified by the presence of H. Pylori infection Demographics Absence of H.Pylori n (%) Presence of H. Pylori n (%) P- value Age category < 0.001 18-44 7530966 (28.52) 5265 (21.14) 45-64 7291281 (27.61) 9160 (36.77) >65 11585675 (43.87) 10485 (42.09) Sex < 0.001 Males 11499721 (43.55) 13590 (54.56) Females 14908201 (56.45) 11320 (45.44) Race < 0.001 White 17386322 (65.84) 9201 (36.97) Black 4163646 (15.77) 7385 (29.65) Hispanic 3121905 (11.82) 5035 (20.21) Asian/Pacific Islander 753370 (2.85) 1720 (6.90) Native American 180460 (0.68) 305 (1.22) Other 802220 (3.03) 1255 (5.03) Primary expected payer < 0.001 Medicare 12342984 (46.74) 10430 (41.87) Medicaid 4943690 (18.72) 6095 (24.47) Private 7090512 (26.85) 5300 (21.28) Uninsured 1112791 (4.21) 2125 (8.53) Median household income < 0.001 Lowest quartile 8076010 (30.58) 9610 (38.58) Second quartile 7173688 (27.16) 6150 (24.69) Third quartile 6040107 (22.87) 5315 (21.34) Highest quartile 5118117 (19.38) 3835 (15.4) Underlying comorbidity GERD 4971195 (18.82) 6380 (25.61) < 0.001 HLD 8691215 (32.91) 8140 (32.68) 0.74 Smoking 9615615 (36.41) 9910 (39.78) < 0.001 Diabetes 7526730 (28.5) 8055 (32.34) < 0.001 HTN 15035811 (56.94) 15500 (62.22) < 0.001 Obesity 4930814 (18.67) 4195 (16.84) 0.002 OSA 1966585 (7.44) 1230 (4.93) < 0.001 IBD 291230 (1.1) 335 (1.34) 0.11 Fatty Liver 754450 (2.85) 1460 (5.86) < 0.001

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. NAFLD is associated with changes in the gut microbiota and has an interplay with the body’s immune response. These changes may contribute to increased risk of infections. The current study was aimed at assessing the relationship between the presence of NAFLD and the risk of bacterial gastrointestinal (GI) infections. Methods: We queried the National Inpatient Sample (NIS) database in 2020 and stratified the patients based on presence of NAFLD. Information was collected regarding patient demographics, hospital characteristics, Charlson comorbidity Index, coexisting comorbidities (GERD,HLD, smoking, diabetes, hypertension, obesity, OSA, IBD), as well as bacterial gastrointestinal infections. Multivariate analysis was used to identify association between NAFLD and bacterial GI infections, after adjusting for confounding factors. Results: A total of 26 million patients were admitted in 2020. Of these, 755,910 (2.85%) patients had the presence of NAFLD. The majority of the patients in the NAFLD group were over 65 years of age (46.1%), female (54.2%), had medicare (51.4%), and were in the lowest income quartile (30.9%) (Table 1). There was a higher prevalence of bacterial GI infections in patients with NAFLD than those without (1.6% vs 0.9%, P< 0.001). The incidence of Clostridium difficile (1.3% vs 0.8%, P< 0.001), Escherichia coli(0.3% vs 0.01%, P< 0.001), as well as Salmonella (0.07% vs 0.03%, P< 0.001) was higher in the NAFLD group compared to the non-NAFLD group . On univariate analysis, the presence of fatty liver was associated with a statistically significant higher odds of developing GI infections (adjusted odds ratio [aOR]-1.75, 95% CI- 1.68-1.83, P< 0.001). After adjusting for confounding factors, the results remained statistically significant (aOR-1.38, 95% CI, P< 0.001) (Figure 1). Conclusion: Our study demonstrates an increase in risk of gastrointestinal infections in patients with NAFLD. Specifically, there was an increased risk of Clostridioides difficile, Escherichia coli, and Salmonella. Prior studies have associated this risk to immune deficiencies and gut microbiota changes seen in NAFLD. Based on prior studies and our current results, we hypothesize that the immune and microbiota changes seen within NAFLD potentially contribute to the increased risk of gastrointestinal infections. Further prospective studies are needed to further clarify this association.Figure 1.: Forest Plot depicting the associations between bacterial GI infections and study variables. Table 1. - Patient demographics, comorbidities, and presence of gastrointestinal infections, stratified by the presence of absence of underlying non-alcoholic fatty liver disease Demographics Absence of NAFLD n(%) Presence of NAFLD n (%) P- value Age category < 0.001 18-44 7,414,871(28.9) 121,360(16.0) 45-64 7,014,496(27.3) 285,945(37.8) >65 11,247,555(43.8) 348,605(46.1) Sex < 0.001 Males 11,167,501(43.5) 345,810(45.7) Females 14,509,421(56.5) 410,100(54.2) Race < 0.001 White 16,892,682(65.8) 502,850(66.5) Black 4,088,746(15.9) 82,285(10.9) Hispanic 3,006,105(11.7) 120,835(15.9) Asian/Pacific Islander 734,530(2.9) 20,560(2.7) Native American 178,830(0.7) 1,935(0.8) Other 797,395(3.0) 6,080(2.5) Primary expected payer < 0.001 Medicare 11,965,204(46.6) 388,210(51.4) Medicaid 4,837,650(18.8) 112,135(14.8) Private 6,895,562(26.9) 200,250(26.5) Uninsured 1,084,341(42.2) 30,575(4.0) Median household income < 0.001 Lowest quartile 7,852,345(30.6) 233,275(30.9) Second quartile 6,970,118(27.1) 209,720(27.7) Third quartile 5,869,792(22.9) 175,630(23.2) Highest quartile 4,984,667(19.4) 137,285(18.1) Charlson Comorbidities < 0.001 0 8,884,263(34.6) 13,150(1.7) 1 4,856,220(18.9) 142,715(18.9) 2 3,453,565(13.4) 128,725(17.0) >3 8,482,874(33.0) 471,320(62.3) Underlying comorbidity GERD 4,769,150(18.6) 208,425(27.6) < 0.001 HLD 8,400,750(32.7) 298,605(39.5) < 0.001 Smoking 9,359,320(36.4) 266,205(35.2) < 0.001 Diabetes 7,186,560(27.9) 348,225(46.07) < 0.001 HTN 14,537,211(56.6) 514,100(68.0) < 0.001 Obesity 4,685,809(18.2) 249,200(32.9) < 0.001 OSA 1,866,635(7.3) 101,180(13.4) < 0.001 Bacterial GI infections 231,405(0.9) 11,850(1.6) < 0.001 IBD 278,615(1.0) 12,950(1.7) < 0.001

Objectives Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD. Methods National Inpatient Sample 2016–2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics. Results Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001). Conclusion Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.

e20003 Background: Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of Clostidium difficile infection (CDI) due to use of cytotoxic chemotherapy, broad-spectrum antibiotics, and sustained neutropenia. Because of the immunocompromised nature of these patients, the prevalence rates of CDI in HSCT recipients are high. In this study we evaluate the impact of CDI on in-hospital outcomes. Methods: We included all patients with a prior diagnosis or a procedure code for HSCT using ICD-10 codes from National Inpatient Sample. We excluded patients admitted for less than 14 days to exclude admissions for elective chemotherapy or catheter placement. Patients were stratified into two groups based on the presence of CDI. Information was collected regarding patient demographics, Charlson comorbidities, underlying hematologic disease, resource utilization (LOS and total hospitalization charges), and outcomes. The outcomes included sepsis, shock, acute kidney injury, ICU admission, and in-hospital mortality. The association between CDI and outcomes was studied using multivariate analysis. Results: 62,415 patients were included in the study. Of them, 5,275 (8.5%) patients developed CDI. The majority of the patients with CDI were White (70.4%), men (57.1%), and aged between 45-64 years (52.5%). Patients with CDI had a higher incidence of sepsis (21.1% vs. 16.5%), shock (8.1% vs. 5.8%), AKI (23.8% vs. 19.4%), ICU admission (9.6% vs. 7.6%) and in-hospital mortality (5.8% vs. 4%). After adjusting for confounding factors, CDI was associated with a 32% higher odds of in-hospital mortality (aOR-1.32, 95% CI-1.01-1.74, p-0.046). CDI was also associated with 26% higher odds of developing shock (aOR-1.26, 95% CI-1.01-1.72, p-0.013) and 27% higher odds of developing AKI (aOR-1.27, 95% CI-1.09-1.49,p-0.002). No statistically significant difference was noted in the risk of ICU admission between the two groups. Patients with CDI had a longer length of stay (29.5 days vs. 24.8 days, p < 0.001) and higher hospitalization charges ($400,017 vs. $508,090, p < 0.001). Conclusions: Our study suggested a relationship between CDI and worse outcomes in HSCT recipients. Physicians should be aware of this association and promptly recognize and initiate treatment in these patients to improve outcomes. [Table: see text]

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory condition. Non alcoholic fatty liver disease is associated with changes in the gut microbiota and has interplay with the body’s immune response. Interestingly, the risk factors for eosinophilic esophagitis are similar to those with NAFLD such as diabetes, obesity, inflammatory bowel disease and celiac disease. In this study, we aim to assess if an association exists between NAFLD and EoE. Methods: National Inpatient Sample (NIS) database 2020 was used to stratify patients based on the presence of NAFLD. ICD-10 codes were used to identify patients with NAFLD and EoE. Information was collected regarding patient demographics, hospital characteristics, Charlson comorbidity index, coexisting comorbidities (GERD, hyperlipidemia, smoking, diabetes, hypertension, obesity, obstructive sleep apnea(OSA), inflammatory bowel disease (IBD), asthma, atopic dermatitis, celiac disease, mixed connective tissue disorders as well as irritable bowel syndrome (IBS)). Multivariate analysis was used to identify the relationship between NAFLD and EoE after adjusting for confounding factors. Results: Out of 26 million patients, only 4,820 (0.018%) patients had EoE. The majority of the patients in the EoE group between 18 and 44 years of age (47.82%), male (54.05%), had private insurance (50.1%) and were in the highest income quartile (29.25%). There was a higher prevalence of EoE in patients with NAFLD than those without (6.1% vs 2.7%, P< 0.001). Patients with EoE had a higher prevalence of GERD, asthma, atopic dermatitis, celiac disease, mixed connective tissue disorder, and irritable bowel syndrome compared to patients without EoE (Table 1). On univariate analysis, a statistically significant positive association was noted between NAFLD/NASH and eosinophilic esophagitis (aOR- 2.21,95% CI-1.70-2.88, P< 0.001). The association was noted to be stronger after adjusting for confounding factors (aOR-2.53, 95% CI-1.93-3.32, P< 0.001) (Figure 1). Conclusion: Our study demonstrates a notable increase in the risk of EoE in patients with NAFLD. A previous study reported a trend towards increased risk of EoE in patients with NAFLD, however the results were not statistically significant due to smaller sample size.Using larger database, our suggests that an association exists between EoE and NAFLD. We hypothesize that immune changes in patients with NAFLD may contribute to the increased risk of EoE.Figure 1.: Forest plot describing the association between EoE and study variables. Table 1. - Patient characteristics and comorbidities stratified by the presence of EoE Demographics Absence of Eosinophilic Esophagitis n (%) Presence of Eosinophilic Esophagitis n (%) P-value Age category < 0.001 18-44 7,533,926 (28.51) 2,305 (47.82) 45-64 7,298,996 (27.62) 1,445 (29.98) 65"}" > >65 11,595,090 (43.87) 1,070 (22.2) Sex < 0.001 Males 11,510,706 (43.55) 2,605 (54.05) Females 14,917,306 (56.45) 2,215 (45.95) Race < 0.001 White 17,391,612 (65.81) 3,920 (81.33) Black 4,170,666 (15.78) 365 (7.57) Hispanic 3,126,595 (11.83) 345 (7.16) Asian/Pacific Islander 755,040 (2.86) 50 (1.04) Native Americans 180,755 (0.68) 10 (0.21) Other 803,345 (3.04) 130 (2.7) Primary expected payer < 0.001 Medicare 12,352,079 (46.74) 1,335 (27.7) Medicaid 4,949,095 (18.73) 690 (14.32) Private 7,093,397 (26.84) 2,415 (50.1) Uninsured 1,114,716 (4.22) 200 (4.15) Median household income < 0.001 Lowest quartile 8,084,715 (30.59) 905 (18.78) Second quartile 7,178,683 (27.16) 1,155 (23.96) Third quartile 6,044,072 (22.87) 1,350 (28.01) Highest quartile 5,120,542 (19.38) 1,410 (29.25) Charlson Comorbidities < 0.001 0 8,895,473 (33.66) 1,940 (40.25) 1 4,997,520 (18.91) 1,415 (29.36) 2 3,581,665 (13.55) 625 (12.97) 3"}" > >3 8,953,354 (33.88) 840 (17.43) Underlying comorbidity GERD 4,976,005 (18.83) 1,570 (32.57) < 0.001 HLD 8,698,165 (32.91) 1,190 (24.69) < 0.001 Smoking 9,624,180 (36.42) 1,345 (27.9) < 0.001 Diabetes 7,534,160 (28.51) 625 (12.97) < 0.001 HTN 15,049,406 (56.94) 1,905 (39.52) < 0.001 Obesity 4,934,194 (18.67) 815 (16.91) 0.16 OSA 1,967,415 (7.44) 400 (8.3) 0.33 IBD 291,310 (1.10) 255 (5.29) < 0.001 Asthma 1,827,790 (6.92) 1,045 (21.68) < 0.001 Atopic dermatitis 6,905 (0.03) 10 (0.21) < 0.001 Celiac disease 36,830 (0.14) 80 (1.66) < 0.001 Mixed Connective tissue disorders 356,145 (1.35) 140 (2.91) < 0.001 Irritable bowel syndrome 249,580 (0.94) 170 (3.53) < 0.001