SEPSIS IN THE SETTINGS OF INFLAMMATORY BOWEL DISEASE: STUDYING THE OUTCOMES OF OVER EIGHT-MILLION PATIENTS

Abstract

Abstract BACKGROUND Inflammatory bowel disease (IBD) is associated with increased risk of infections, attributed to the nature of the disease itself, and the use of immunosuppressive agents in these patients as well. However, the impact of IBD on patients with sepsis is poorly studied. In this analysis, authors aim to investigate the outcomes of sepsis in patients with IBD. METHODS This is an analysis of the National Inpatient Sample Database of the years 2016 to 2019. Using ICD-10 codes, authors identified patients who were admitted with a principal diagnosis of sepsis and those with history of Crohn’s disease (CD) and ulcerative colitis (UC). Primary outcome was mortality difference AND risk of sepsis-related complications. Secondary outcomes included length of stay and charge of care. Multivariate logistic analysis was performed using Stata/BE 17.0. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was <0.05. RESULTS Among a total number of 8,403,578 patients who were admitted for sepsis and included in the study, 61390 (0.73%) and 47504 (0.56%) had a history of CD and UC, respectively. When compared to general population, adjusted odds ratio for mortality were lower in patients with CD than in UC (OR 1.01, p<0.001, 95% CI 0.74 – 0.87 vs OR 0.81, p=0.758, 95% CI 0.93 – 1.09). Increased risk of septic shock observed in UC-sepsis group more than in CD-sepsis group (OR 1.28, p<0.001, 95% CI 1.21 – 1.34 vs OR 1.08, p=0.001, 95% CI 1.03 – 1.13), acute kidney injury (UC OR 1.18, p<0.001, 95% CI 1.13 – 1.23, CD OR 1.11, p<0.001, 95% CI 1.06 – 1.15) and non-variceal upper GI bleeding (UC OR 1.64, 95% CI 1.50 – 1.79, p<0.001vs CD OR 1.15, 95% CI 1.04 – 1.27, p=0.004). Both groups had prolonged length of stay, more prolonged with UC (UC Coefficient 1.04 days, 95% CI 0.85 – 1.24, p<0.001, vs CD Coefficient 0.67, 95% CI 0.51 – 0.82, p<0.001) and in charge of care (UC Coefficient 13505$, 95% CI 10561 – 16449, p<0.001 vs CD Coefficient 5855$, 95% CI 3251 – 8189, p<0.001) when compared to admitted sepsis patients without prior history of IBD. CONCLUSION Patient admitted with sepsis have worse outcomes in the settings of inflammatory bowel diseases, represented by higher risk septic shock, acute kidney injury, non-variceal upper GI bleeding, prolonged length of stay and increased charge of care. These outcomes noticed to be more severe in sepsis patients with ulcerative colitis than those with Crohn’s disease. Clinicians and intensivist should be aware of the high risk associated with inflammatory bowel disease in sepsis patients, especially in those with ulcerative colitis.