Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.
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Goren Idan, Fallek Boldes Ortal, Boldes Tomer, Knyazev Oleg, Kagramanova Anna, Limdi Jimmy K, Liu Eleanor, Sethi-Arora Karishma, Holvoet Tom, Eder Piotr, Bezzio Cristina, Saibeni Simone, Vernero Marta, Alimenti Eleonora, Chaparro María, Gisbert Javier P, Orfanoudaki Eleni, Koutroubakis Ioannis E, Pugliese Daniela, Cuccia Giuseppe, Calviño Suarez Cristina, Ribaldone Davide Giuseppe, Veisman Ido, Sharif Kassem, Festa Stefano, Aratari Annalisa, Papi Claudio, Mylonas Iordanis, Mantzaris Gerassimos J, Truyens Marie, Lobaton Ortega Triana, Nancey Stéphane, Castiglione Fabiana, Nardone Olga Maria, Calabrese Giulio, Karmiris Konstantinos, Velegraki Magdalini, Theodoropoulou Angeliki, Shitrit Ariella Bar-Gil, Lukas Milan, Vojtechová Gabriela, Ellul Pierre, Bugeja Luke, Savarino Edoardo V, Fischler Tali Sharar, Dotan Iris, Yanai Henit
Аннотация
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-month 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 month and mortality at 12 month 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 (UC)}, 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 UC diagnosis was the sole risk factor for complication at 6 months (aOR 1.5). Clostridioides difficile infection 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.