Predictors of mortality in inflammatory bowel disease patients treated for pneumonia

Abstract

Background: Community-acquired pneumonia is among the most common infections affecting ulcerative colitis and Crohn’s disease patients. Data regarding epidemiology and outcomes of pneumonia in inflammatory bowel disease patients is lacking. We aimed to identify predictors of adverse outcomes among inflammatory bowel disease patients treated for pneumonia. Methods: This was a retrospective cohort study that included adult patients admitted to Sheba Medical Center for pneumonia between 2012 and 2018. Data was collected from an electronic repository of all emergency department admissions and included tabular demographic and clinical variables and free-text physician records. Pneumonia cases were extracted using the International Classification of Diseases (ICD-10) coding. Results: Of 16,732 admissions with pneumonia, 97 were inflammatory bowel disease patients (45 Crohn’s disease; 52 ulcerative colitis). We found a similar rate of 30-day mortality among inflammatory bowel disease and non-inflammatory bowel disease patients (12.1% versus 11.3%, p = 0.824) and between Crohn’s disease and ulcerative colitis patients (11.1% versus 11.5%, p = 0.947). There was an increased hospitalization rate among inflammatory bowel disease patients (92.8% versus 85.6%, p = 0.045), but similar hospitalization duration (4 versus 4 days, p = 0.384). Crohn’s disease patients had a shorter hospitalization duration compared with ulcerative colitis patients (3 versus 5.5 days, p = 0.029). Bronchiectasis (adjusted odds ratio 60.95, 95% confidence interval 2.72–1364.39, p = 0.01) and opioids use (adjusted odds ratio 13.21, 95% confidence interval 1.29–135.18, p = 0.03) were associated with an increased 30-day mortality rate in inflammatory bowel disease patients. Conclusion: This is the first study to identify predictors of mortality in inflammatory bowel disease patients with pneumonia. The rate of mortality and hospitalization duration of stay were similar among inflammatory bowel disease and non-inflammatory bowel disease patients. Use of opioids and presence of bronchiectasis were associated with a higher risk of mortality in inflammatory bowel disease patients with pneumonia.

Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection

“…Burisch et al [ 33 ] described a higher rate of all-cause hospitalization among IBD patients, particularly in the early years from diagnosis. Additionally, in a previous study by our group about IBD patients treated for pneumonia, we found a higher rate of hospitalization, though no difference in adverse outcomes was observed [ 34 ]. This study indicates that patients with IBD who had had a history of recent hospitalization for any reason prior to a UTI episode had an increased risk of hospitalization and 30-day recurrent hospitalization for any reason.…”

Increased bronchiectasis risk and related risk factors in inflammatory bowel disease: a 10-year Korean national cohort study

“…Therefore, the disease burden of IBD may increase in the presence of bronchiectasis. Supporting this notion, a recent study showed that the presence of bronchiectasis is associated with an increased risk of mortality in individuals with IBD who developed pneumonia [ 16 ]. We have provided further robust evidence that bronchiectasis is associated with poor treatment outcomes regarding mortality and healthcare use.…”

“…Comorbid bronchiectasis is believed to exacerbate the disease burden in individuals with IBD. The information on this issue is limited, with only one study indicating that the pneumonia-related mortality rate is higher in individuals with IBD and bronchiectasis than in those without bronchiectasis [ 16 ]. Consequently, whether bronchiectasis results in worse treatment outcomes in individuals with IBD remains unknown.…”