World Congress at ACG2017
Simultaneous Plenary Session 4C: IBD
75 - Trends of Infection Prevalence in Inflammatory Bowel Disease and Effect on Hospitalization Outcomes: A U.S. Perspective 2005-2014
Wednesday, October 18
8:50 AM - 9:00 AM
Location: W414 (Level 4)
Paris Charilaou, MD
Saint Peter's University Hospital
New Brunswick, New Jersey
Award: 2017 Fellows-in-Training Award (IBD Category)
Paris Charilaou, MD1, Kalpit Devani, MD2, Chakradhar M. Reddy, MD3, Mark Young, MD3, Debra Goldstein, MD4
1Saint Peter's University Hospital, New Brunswick, NJ; 2James H. Quillen College of Medicine, East Tennessee University, Johnson City, TN; 3East Tennessee State University, Johnson City, TN; 4Saint Peter's University Hospital, New Brunswick, NJ
Introduction: In more recent years, intensified therapy with immunomodulators in patients with inflammatory bowel disease (IBD), increases the risk of infectious complications. There is no real-world data on prevalence of infections amongst the hospitalized IBD population. We hereby assess infection prevalence among hospitalized IBD patients in the US and examine its impact on hospital outcomes.
Methods: We conducted an observational retrospective cohort study from the National Inpatient Sample (NIS) over the period 2005 to 2014. We included all patients with documented IBD in any discharge diagnosis, using the International Classification of Diseases-9-Clinical Modification (ICD-9-CM) codes 555.* and 556.* . We excluded cases with missing data on age, gender or inpatient mortality. ICD-9 codes identified infections of the urinary tract, intra-abdominal/peritoneal, skin/soft tissue and of respiratory system, as well as other covariates (Table 1). Chi-square and t-tests were used for bivariate comparisons. The impact of infection on mortality, costs and length of stay (LOS) was assessed by multivariate mixed-model logistic, log-transformed linear and accelerated-failure-time parametric regressions (Table 1), respectively. All analyses were survey-weighted, yielding national estimates.
Results: A total of 2,655,480 patients met inclusion criteria and 656,283 patients (24.7%) had documented infection. Mean age was 52 years and 57.7% were females. Overall inpatient mortality was 1.5%. Comparison between infection and no-infection groups are shown in Table 2. Infection prevalence increased from 18.8% to 28.7% (p-trend < 0.001). Trends of hospital outcomes trends in the infection group are shown in Table 3. Aggregate costs in the infection group increased from $578 million in 2005 to $1.534 billion in 2014. After confounder adjustment, single-source infection without sepsis led to a modest 12% increase in mortality (p < 0.001), whereas multi-source infection doubled the risk of death (adjusted odds ratio [aOR]=2.26; p< 0.001; Table 1). Presence of sepsis increased mean costs by 18% (aOR=1.18; p < 0.001). LOS was increasingly prolonged by 33% in non-septic single-source patients, up to 2.4 times in septic, multiple-source patients (p < 0.001).
Discussion: Prevalence of infections in IBD patients is increasing over the last decade, while mortality rates in these patients are decreasing. Infections in IBD independently increase mortality risk and significantly increase hospital resource utilization.
Supported by Industry Grant: No
Citation: . TRENDS OF INFECTION PREVALENCE IN INFLAMMATORY BOWEL DISEASE AND EFFECT ON HOSPITALIZATION OUTCOMES: A U.S. PERSPECTIVE 2005-2014. Program No. 75. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.