S0674 Venous Thromboembolism Is Increased in Crohn's Disease and Ulcerative Colitis Patients Infected With Clostridiodes difficile Compared to Inflammatory Bowel Disease Alone

Abstract

INTRODUCTION: Inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE). Clostridiodes Difficile Infection (CDI) may have a potential added risk on VTE in patients with IBD. We sought to investigate the prevalence of VTE in IBD patients with and without CDI. METHODS: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine—Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) who were diagnosed with either Crohn's disease (CD) or ulcerative colitis (UC) between 1999 and 2020 who were diagnosed with CDI. We investigated the prevalence of first ever episode of deep vein thrombosis (VTE) and pulmonary embolism (PE) post CDI compared to IBD patients who never had CDI. RESULTS: Of the 61,633,790 individuals in the database, we identified 184,390 (0.3%) patients with CD and 147,420 (0.24%) patients with UC, of whom 5,900 (3.2%) and 8,270 (5.6%) patients had CDI, respectively. Of CD patients who were diagnosed with CDI 750/5,900 patients developed their first ever episode of VTE with a prevalence of 12.7% compared to CD patients who never had CDI 5,150/166,130 with a prevalence of 7%, P < 0.001. Patients with CD who had CDI were more likely to develop first ever episode of VTE when compared to individuals with CD who never had CDI [OR: 1.96, 95% CI: 1.81–2.12, P < 0.001]. Similarly, of UC patients who were diagnosed with CDI 580/6,780 patients developed their first ever episode of VTE with a prevalence of 7% compared to UC patients who never had CDI 7,690/132,370 with a prevalence of 4.8%, P < 0.001. Patients with UC who had CDI were more likely to develop first ever episode of VTE when compared to individuals with UC who never had CDI [OR: 1.47, 95% CI: 1.35–1.61, P < 0.001]. CONCLUSION: This is the largest individual study investigating prevalence of VTE in IBD patients with and without CDI. We found that CD and UC with Clostridiodes Difficile infection were 1.5 and 2 times more likely to have VTE, respectively, when compared to those who never had an infection.Figure 1.: The prevalence of venous thromboembolism (pulmonary embolism and deep vein thrombosis) in patients with inflammatory bowel disease with and without Clostridiodes Difficile Infection.