Abstract
Abstract Background Community-acquired pneumonia is among the most common infections affecting ulcerative colitis (UC) and Crohn’s disease (CD) patients. Data regarding epidemiology and outcomes of pneumonia in inflammatory bowel disease (IBD) patients is lacking. We aimed to investigate the epidemiology, natural history and predictors of adverse outcomes in IBD patients treated for pneumonia. Methods This was a retrospective cohort study that included consecutive adult patients that were admitted to Sheba Medical Center for pneumonia from an electronic repository of all emergency department admissions between 2012 and 2018. Data included tabular demographic and clinical variables and free-text physician records. Pneumonia cases were extracted using ICD10 coding. We compared the characteristics and outcomes of IBD and non-IBD patients, and CD and UC patients. We also examined the association of clinical and laboratory variables with thirty-day mortality. Results Of 16,732 admissions with pneumonia, 97 were IBD patients (45-CD; 52-UC). IBD patients were younger than non-IBD patients (66.8 years vs. 70.2 years, p-value = 0.077). Comorbidities such as diabetes (16.5% vs. 22.8%, p = 0.142), hypertension (30.9% vs. 41.4%, p = 0.037) and congestive heart failure (15.5% vs. 19.2%, p = 0.35) were more prevalent among non-IBD patients. Use of immunosuppressant and biological medications was more common among IBD patients (corticosteroids [19.6% vs. 9.7%, p = 0.001], azathioprine [5.2% vs. 0.4%, p < 0.001], vedolizumab [2.1% vs. 0%, p < 0.001], tumour necrosis factor-α inhibitors [6.2% vs. 0%, p < 0.001]). Thirty-day mortality rate was similar among IBD patients and non-IBD patients (12.1% vs. 11.3%, p = 0.824). We found increased hospitalisation rate among IBD patients (92.8% vs. 85.6%, p = 0.045), but similar length of stay in hospital (6.2 days vs. 6.2 days, p = 0.989). Thirty-day mortality rate (11.1% vs. 11.5%, p = 0.947) and hospitalisation rate (93.3% vs. 92.3%, p = 0.846) were similar in CD and UC patients. On the other hand, CD patients were younger (57.6 years vs. 74.8 years, p < 0.01) and had a shorter length of stay in hospital (4.8 days vs. 7.5 days, p = 0.046) compared with UC patients. Using regression analysis model, bronchiectasis (Adjusted odds ratio [AOR] 109.6, p = 0.008, opioid use (AOR 13.0, p = 0.03) and PPIs use (AOR 5.9, p = 0.05) were independently associated with the risk of 30-day mortality in IBD patients. Conclusion This is the first study to identify predictors of mortality in IBD patients with pneumonia. The rate of mortality and duration of stay were similar between IBD and non-IBD patients. Use of PPIs, opioids and presence of bronchiectasis were associated with a higher risk of mortality in IBD patients with pneumonia.
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