Predictors for hospitalization and outpatient visits in patients with inflammatory bowel disease

Sulz, Michael Christian; Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella Matteucci; Wurm, Johannes; Känel, Roland von; Vavricka, Stephan R.; Meyenberger, Christa; Sagmeister, Markus

doi:10.1097/meg.0b013e32836019b9

Cited by 29 publications

(20 citation statements)

References 9 publications

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“…The other risk factor found in this study was anti-TNF use (HR, 4.34; 95% CI, 1.75 to 10.75; p = 0.002). This result is consistent with a prospective cohort study identifying predictors of hospitalisation and outpatient visits in patients with IBD, supporting the idea that biologics use is a significant predictor of these poor clinical outcomes in CD patients [ 12 ].…”

Section: Discussionsupporting

confidence: 90%

Disparity in Crohn’s disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares

Kim

Lee

Jang

et al. 2018

Korean J Intern Med

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Background/AimsE-health technologies have been implemented for the management of Crohn’s disease (CD). We aimed to identify differences between patient activities at home and at routine clinic visits using a web-based self-reporting CD symptom diary (CDSD) and to determine the impact of this disparity on clinical outcomes.MethodsPatients with CD from three tertiary hospitals were invited to assess their symptoms at least once a week using CDSD. We identified patients who showed disparities in disease activity (high activity at home but normal at the next hospital visit) and evaluated clinical outcomes of these patients such as unscheduled visits due to flares using Kaplan-Meier analyses.ResultsOne hundred and forty-three patients recorded their symptoms weekly for at least 3 consecutive months and were included. Forty-eight patients (33.6%) showed disparate disease activities between at home and at the next outpatient clinic visit. The cumulative risk of unscheduled visits was significantly higher in this disparity group than in the concordant group (p = 0.001). Disparity in activity (p = 0.003), and anti-tumor necrosis factor use (p = 0.002) were independent risk factors of unscheduled visits due to disease flares.ConclusionsDisparity in disease activity is considerable in CD patients and is related to the risk of unscheduled hospital visit.

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Section: Discussionsupporting

confidence: 90%

Disparity in Crohn’s disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares

Kim

Lee

Jang

et al. 2018

Korean J Intern Med

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“…According to our analysis, IBD was more prevalent in women compared to men (403/100,000 vs. 331/100,000), and was lower in persons aged 17 years and younger (24/100,000) as compared with all other age groups. Similarly, a higher rate of female compared to male IBD patients was reported for the Swiss IBD Cohort, [ 36 , 37 ] as well as for other countries in Europe [ 17 , 35 ]. In US children, prevalence rates were estimated to be 43/100,000 for CD and 28/100,000 for UC, respectively, which is slightly higher than in our findings [ 38 ].…”

Section: Discussionmentioning

confidence: 54%

“…In other words, we possibly underestimate the number of patients with IBD. Reasons for the comparably low sensitivity might, firstly, be due to the fact that we were unable to detect patients with mild disease who weren’t treated with one of the defined medications [ 37 ]. Secondly, there might be incident cases without a history of IBD-related medications.…”

Section: Discussionmentioning

confidence: 99%

Trends in prevalence, mortality, health care utilization and health care costs of Swiss IBD patients: a claims data based study of the years 2010, 2012 and 2014

et al. 2017

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BackgroundReal-life data on inflammatory bowel disease (IBD) prevalence and costs are scarce. The aims of this study were to provide an overview of the prevalence, mortality, health care utilization and costs of IBD patients in Switzerland in the years 2010, 2012, and 2014.MethodsBased on claims data of the Helsana-Group, prevalence of IBD was assessed for 2010, 2012 and 2014. Mortality rates, costs (inpatient, outpatient, medication costs) and utilization (visits, hospitalizations) were compared between patients with and without IBD, and between IBD patients treated with and without biologics. Results were extrapolated to the Swiss general population using national census data. Multivariate linear regression was used to identify socio-demographic and regional factors influencing total costs.ResultsThe overall extrapolated prevalence rates of IBD were 0.32% in 2010, 0.38% in 2012, and 0.41% in 2014. Mortality rate didn’t differ between the IBD and non-IBD population. Costs increased annually by 6% in IBD versus 2.4% in non-IBD subjects, which was solely due to increased outpatient costs. Almost one-fourth of IBD patients were hospitalized at least once a year. Costs were higher in IBD patients treated with biologics (OR = 3.98, CI: 3.72-4.27, p < 0.001) when compared to IBD patients without biologic therapies. Over 70% of the total costs in IBD patients treated with biologics were due to drug costs, compared with 28% in patients without use of biologic therapies, whereas inpatient costs didn’t differ.ConclusionsThe prevalence of IBD seems to be increasing in Switzerland. Outpatient costs increased substantially, while no decrease in inpatient costs was found. Treatment of IBD is more and more based on biologic therapies.Electronic supplementary materialThe online version of this article (10.1186/s12876-017-0681-y) contains supplementary material, which is available to authorized users.

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“…The major strength of this study is the ability to capture outcomes in a large cohort of IBD patients followed longitudinally. Furthermore, we were able to control for patient-specific factors known to be associated with poor outcomes in IBD, including age, sex, race, elevated CRP, use of immunomodulators or biologics, smoking status, prior resections and Montreal score in patients with Crohn’s disease, and disease duration (19-28). In addition to controlling for these variables, our analyses also took into account serum albumin levels.…”

Section: Discussionmentioning

confidence: 99%

Zinc Deficiency is Associated with Poor Clinical Outcomes in Patients with Inflammatory Bowel Disease

Siva

Rubin

Gulotta

et al. 2017

Inflammatory Bowel Diseases

124

100

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Introduction Zinc plays a pivotal role in wound repair, tissue regeneration, and the immune response. Although zinc deficiency is common in patients with inflammatory bowel disease (IBD), the impact of low serum zinc levels on disease course is not known. Methods Patients enrolled in a prospectively collected IBD registry with at least two serum zinc measurements were included in the analysis. Using a logistic regression model, rates of IBD-related surgeries, IBD-related hospitalizations, and IBD-related complications were evaluated following a diagnosis of zinc deficiency (serum concentration <0.66 mcg/ml) compared to those with normal zinc concentrations. In patients who were zinc deficient, outcomes were also analyzed between those who had normalization of zinc levels within 12 months and those who remained deficient. Results A total of 773 patients with Crohn’s disease (CD) and 223 with ulcerative colitis (UC) were included in the analysis. After adjusting for covariates, zinc deficiency was associated with an increased risk of subsequent hospitalizations, surgeries, and disease-related complications in patients with CD and UC (CD: hospitalizations, OR 1.44, 95% CI [1.02-2.04]; surgeries, 2.05 [1.38-3.05]; complications, 1.50 [1.04-2.15]; UC: hospitalizations, 2.14 [1.07-4.29]; surgeries, 1.64 [0.59-4.52]; complications, 1.97 [0.94-4.11]). Normalization of zinc was associated with improvement in these outcomes in patients with both CD and UC. Conclusion IBD patients with serum zinc deficiency are more likely to have adverse disease-specific outcomes. As these outcomes improve with normalization of zinc, the results from this study support the role for close monitoring and replacement of zinc in patients with IBD.

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Predictors for hospitalization and outpatient visits in patients with inflammatory bowel disease

Abstract: Several highly significant clinical predictors for resource consumption in IBD were identified that might be considered in medical decision-making. In terms of resource consumption and its predictors, CD and UC show a different behaviour.

Cited by 29 publications

References 9 publications

Disparity in Crohn’s disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares

Disparity in Crohn’s disease activity between home and clinics is associated with unscheduled hospital visits due to disease flares

Trends in prevalence, mortality, health care utilization and health care costs of Swiss IBD patients: a claims data based study of the years 2010, 2012 and 2014

Zinc Deficiency is Associated with Poor Clinical Outcomes in Patients with Inflammatory Bowel Disease

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