Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.

Journal of Crohn's & colitis Pub Date : 2024-10-21 DOI:10.1093/ecco-jcc/jjae161

Idan Goren, Ortal Fallek Boldes, Tomer Boldes, Oleg Knyazev, Anna Kagramanova, Jimmy K Limdi, Eleanor Liu, Karishma Sethi-Arora, Tom Holvoet, Piotr Eder, Cristina Bezzio, Simone Saibeni, Marta Vernero, Eleonora Alimenti, María Chaparro, Javier P Gisbert, Eleni Orfanoudaki, Ioannis E Koutroubakis, Daniela Pugliese, Giuseppe Cuccia, Cristina Calviño Suarez, Davide Giuseppe Ribaldone, Ido Veisman, Kassem Sharif, Annalisa Aratari, Claudio Papi, Iordanis Mylonas, Gerassimos J Mantzaris, Marie Truyens, Triana Lobaton, Stéphane Nancey, Fabiana Castiglione, Olga Maria Nardone, Giulio Calabrese, Konstantinos Karmiris, Magdalini Velegraki, Angeliki Theodoropoulou, Ariella Bar-Gil Shitrit, Milan Lukas, Gabriela Vojtechová, Pierre Ellul, Luke Bugeja, Edoardo V Savarino, Tali Sharar Fischler, Iris Dotan, Henit Yanai

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引用次数: 0

Abstract

Objectives: Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short, intermediate, and long-term post-discharge complications among these patients.

Methods: A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-months post-discharge IBD-related complication rates defined as: steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6-months and mortality at 12-months among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression.

Results: In a cohort of 654 patients hospitalized for IBD (age 68.9 [interquartile range {IQR}]:63.9-75.2) years, 60.9% ulcerative colitis), 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6-months, and 12-months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs. 33.1%, p=0.8; 40.5% vs. 42.5%, p=0.66; and 4.6% vs. 8%, p=0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3-months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An ulcerative colitis diagnosis was the sole risk factor for complication at 6-months (aOR 1.5). CDI did not significantly impact outcomes or interact with IBD type.

Conclusions: In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1-year.

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因艰难梭菌感染并发炎症性肠病发作而住院的老年患者出院后的预后。

目的：炎症性肠病（IBD）发作并同时伴有艰难梭菌感染（CDI）的老年住院患者被认为是IBD相关并发症的高危人群。我们旨在评估这些患者出院后的短期、中期和长期并发症：一项回顾性多中心队列研究，评估因 IBD 复发而住院、接受 CDI 检测（阳性或阴性）并出院的老年人（≥60 岁）的治疗效果。主要结果是出院后 3 个月的 IBD 相关并发症发生率，定义为：类固醇依赖、再次入院（急诊科或住院）、IBD 相关手术或死亡率。我们对出院后 6 个月内的 IBD 相关并发症和 12 个月的死亡率进行了次要评估。并发症的风险因素通过多变量逻辑回归进行评估：在654名因IBD住院的患者（年龄68.9[四分位间差{IQR}]：63.9-75.2)岁，60.9%为溃疡性结肠炎）中，23.4%为CDI阳性。CDI 阳性和 CDI 阴性患者出院后 3 个月和 6 个月的并发症发生率以及 12 个月的死亡率没有显著差异（分别为 32% vs. 33.1%，p=0.8；40.5% vs. 42.5%，p=0.66；4.6% vs. 8%，p=0.153）。Charlson 合并症指数是 3 个月内出现并发症的唯一重要风险因素（aOR 1.1），而使用美沙拉明（5-氨基水杨酸 [5-ASA]）则具有保护作用（aOR 0.6）。溃疡性结肠炎诊断是 6 个月后并发症的唯一风险因素（aOR 1.5）。CDI对预后无明显影响，也不与IBD类型相互影响：结论：在因 IBD 复发住院并随后出院的老年 IBD 患者中，并发 CDI 感染与出院后的 IBD 相关并发症或 1 年内的死亡率无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of Crohn's & colitis

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