Excess burden of critical illness related to inflammatory bowel disease

Abstract

Background Although inflammatory bowel disease (IBD) is associated with major morbidity and mortality, few studies have evaluated its associated burden of critical illness. Aims To examine the epidemiology and outcome of intensive care unit (ICU) admission among patients with IBD in North Brisbane, Australia. Methods A population‐based cohort design was used. All admissions to ICU serving the Metro North Hospital and Health Service among adult residents during 2017–2019 were included. Data were obtained from ICU clinical information systems with linkages to statewide admissions and death registries. Results Among 9011 ICU admissions, 101 (1.1%) were among patients with IBD, of which 57 (0.6%) and 44 (0.5%) had ulcerative colitis (UC) and Crohn disease (CD) respectively. The incidence of ICU admission was 379, 1336, 1514 and 1429 per 100 000 annually among those without IBD, CD, UC and IBD respectively. Patients with IBD were at excess risk for admission across all age groups, with women aged <50 years at highest risk and men thereafter. The all‐cause 90‐day case‐fatality rates following ICU admission were not significantly different among patient groups and were 18%, 12%, 15% and 12% for CD, UC, IBD and non‐IBD respectively. However, as compared with non‐IBD patients, those with CD (151.8 vs 39.4 per 100 000; relative risk (RR) 3.85; 95% confidence interval (CI) 1.25–9.02; P = 0.013), UC (159.4 vs 39.4 per 100 000; RR 4.05; 95% CI 1.48–8.84; P = 0.005) and IBD (155.6 vs 39.4 per 100 000; RR 3.95; 95% CI 1.96–7.10; P = 0.002) were at significantly higher risk for mortality. Conclusions Patients with IBD suffer a major burden of critical illness.

Clinical Presentation and Outcome of Critically Ill Patients with Inflammatory Bowel Disease

“…Taken together, these data show that IBD patients seem not to be overrepresented in their admission rates to the ICU compared to the general population. This is an interesting finding as previous studies have described a higher risk for IBD patients to be admitted to the ICU [5][6][7][8].…”

“…Previous studies have shown that common complications that may require intensive care are caused by fistulas, abscesses, and intestinal obstructions that require surgical intervention and postoperative care, as well as severe systemic symptoms. These symptoms include a loss of intravascular volume and electrolyte derangement caused by severe diarrhea, thromboembolic events, and infections favored by immunosuppressant therapy [5][6][7][8]. Mortality rates of IBD patients admitted to the ICU have been described as ranging from 15 to 19%.…”

“…Mortality rates of IBD patients admitted to the ICU have been described as ranging from 15 to 19%. These studies described age, mechanical ventilation, vasopressor therapy, acute kidney failure, and previous therapy with immunomodulators as risk factors for ICU admission and increased mortality [5][6][7][8].…”