Iron Deficiency Anemia: An Overlooked Complication of Crohn’s Disease

Abstract

Background There are few studies to evaluate the association between iron deficiency anemia (IDA) and Crohn’s disease (CD). We examined this association in a USA-based cohort of patients with CD. Methods We queried the Nationwide Readmission Databases 2018 using the International Classification of Disease, 10th Revision, and Clinical Modification (ICD-10-CM) codes to identify all adult patients admitted with a diagnosis of CD. Primary outcomes were the prevalence of IDA among patients with CD. Secondary outcomes included inpatient mortality, the length of stay, all-cause 30-day non-elective readmission rate, and total cost of hospitalization. Multivariate regression analysis was performed to study the impact of IDA on inpatient mortality and non-elective readmissions. Results Of the 72,076 patients discharged from an index hospitalization for CD, 8.1% had IDA. CD patients with IDA had increased length of stays in days (4, interquartile range (IQR): 2 - 6 vs. 3, IQR: 2 - 5; P < 0.001), increased median total charges ($35,160, IQR: $19,786 - $64,126 vs. $31,299, IQR: $17,226 - $59,561; P < 0.001), and were more common to require blood transfusion during hospitalization (13.6% vs. 3.4%, P < 0.001) compared to CD patients without IDA, respectively. IDA was independently associated with increased odds of all-cause 30-day non-elective readmission (odds ratio (OR): 1.254, 95% confidence interval (CI): 1.154 - 1.363, P < 0.001) and increased odds of all-cause 90-day non-elective readmission (OR: 1.396, 95% CI: 1.302 - 1.498, P < 0.001). Conclusions In a large nationwide cohort of patients hospitalized for CD, we observed a significant burden of IDA. Additionally, we found a significant association between IDA and worse hospitalization outcomes.

Causal association between type 2 diabetes mellitus, inflammatory bowel disease and iron deficiency anemia: A multivariable Mendelian randomization Study

“…In the univariable and multivariable MR study, we systematically assessed the iron de ciency anemia with type 2 diabetes, ulcerative colitis and Crohn's disease risk. Consistent with previous research results 5,[9][10][11]28 , our ndings demonstrated a signi cant positive association between IDA and an increased risk of both T2DM and CD. Furthermore, our multivariable MR analysis substantiated a direct causal relationship between T2DM and IDA, while accounting for the confounding effects of other related diseases.…”

“…IDA poses a signi cant burden among patients hospitalized for Crohn's disease, as shown by a large cohort study conducted in the United States 5 ; another observational study focusing on patients with in ammatory bowel disease (IBD) revealed that approximately one-fth of the cohort experienced anemia primarily due to ID 6 ; recent guidelines from the European Crohn's Disease and Colitis Organization underline the importance of regular screening and prompt treatment for IDA in individuals with IBD 7 ; a recent study reported varying prevalence rates of ID in hospitalized IBD patients, ranging from 13-90%, with an average of 23% 8 . In the context of type 2 diabetes mellitus (T2DM), a retrospective study involving 1,137 patients found that 39.3% had ID, with ID being most prevalent (61.7%) among those with a duration of diabetes less than 5 years 9 ; another study demonstrated an association between IDA and elevated glycosylated hemoglobin concentrations, which signi cantly declined following iron treatment 10 .…”

Deep representation learning for clustering longitudinal survival data from electronic health records

“…Conversely, clusters 2 and 3 were hardly significantly enriched for medical complaints leading up to their first CD diagnosis (Figure 7B). However, the patients in clusters 2 and 3 did appear to progress more rapidly as evident from developing serious complications after CD onset, including complications due to abdominal pain, nausea, vomiting and iron deficiency anemia [26][27][28] (Figure 7B). Interestingly, although patients in clusters 1 and 4 generally had a better prognosis than patients in clusters 2 and 3, the diagnosis trajectories between clusters 1 and 4 did seem to be quite distinct (Figure S6).…”