Inflammatory Bowel Disease Hospitalizations Research Articles

The Relationship Between Loneliness, Social Isolation, and Inflammatory Bowel Disease: A Narrative Review.

There is clear evidence that loneliness and social isolation have profound health consequences. Documenting the associations of loneliness and social isolation with inflammatory bowel disease (IBD) symptoms, disease severity, and treatment outcomes could meaningfully improve health and quality of life in patients with IBD. The purpose of this narrative review was to synthesize the empirical evidence on the associations of loneliness and social isolation with IBD symptoms, disease severity, and treatment outcomes. Articles were identified through systematic database searches. Quantitative studies that enrolled patients with IBD were included if they examined one of the following outcomes: (a) loneliness or social isolation or (b) IBD-related symptoms, disease severity, or treatment outcomes. We identified 1,816 articles after removing duplicates. Of the 18 studies that met the inclusion criteria, 15 were cross-sectional and 3 were longitudinal. Overall, studies found that loneliness was associated with greater disease activity, functional gastrointestinal symptoms, IBD illness stigma, depressive symptoms, daily IBD symptom burden, reduced resilience, and poorer quality of life. Social isolation was associated with higher prevalence of IBD hospitalizations, premature mortality, and depression. Findings suggest that loneliness and social isolation are associated with poorer health and quality of life in patients with IBD. Prospective cohort studies examining the biobehavioral mechanisms accounting for the associations of loneliness and social isolation with IBD-related outcomes are needed to guide the development of psychological interventions for individuals living with IBD.

Sarcopenia is associated with worse outcomes in patients with inflammatory bowel disease: insights from US national hospitalization data

Background Inflammatory bowel disease (IBD) is an inflammatory disorder associated with significant morbidity and mortality. Recent studies have reported sarcopenia as a significant factor affecting the quality of life and outcomes of these patients. Methods We used the National Inpatient Sample 2016–2020 to identify adult patients with IBD. The patients were stratified into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, ICU admission, and need for surgery. Multivariate logistic regression analysis was performed. Results A total of 1 524 820 IBD hospitalizations were included. Of these, 209 615 (9%) were noted to have sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (4.2% vs. 1.2%, P < 0.001), ICU admission (6.5% vs. 2.4%, P < 0.001), and need for abdominal surgery (6.5% vs. 3.5%, P < 0.001). After adjusting for confounders, the presence of sarcopenia was associated with higher odds of in-hospital mortality (adjusted odds ratio: 2.83, 95% confidence interval: 2.66–3.02, P < 0.001) and additional worse outcomes. Conclusion Our study reports that the presence of sarcopenia was associated with an increased risk of death and the need for abdominal surgery. Preventative measures aimed at improving sarcopenia should be taken to prevent worse outcomes in this patient population.

A168 RATES OF CLOSTRIDIOIDES DIFFICILE INFECTIONS REQUIRING HOSPITALIZATION DURING THE COVID-19 PANDEMIC

Abstract Background Clostridium difficile infection (CDI) is the most common cause of nosocomial infectious diarrhea and is associated with a substantial burden of morbidity and mortality. Most cases of CDI are acquired through health care setting contacts, where appropriate infection prevention and control (IPC) measures such as contact isolation and proper hand hygiene have been demonstrated to prevent horizontal transmission. Aims We aimed to evaluate whether there was a reduction in CDI-related hospitalizations during the COVID-19 pandemic when an increased emphasis was placed on maintaining IPC measures. Methods We analyzed data from the National Inpatient Sample (NIS) between January 2018 and November 2020. The NIS is the largest publicly available administrative health database in the United States, capturing ampersand:003E7 million hospital admissions annually. All analyses were weighted for the complex survey design of the NIS. Temporal trends in monthly admissions for patients with CDI defined using International Classification of Disease 10th revision codes and excluding patients with established CDI carrier status were evaluated using joinpoint regression. Changes over time were expressed as monthly percent change (MPC). To establish whether temporal changes were related to a reduction in CDI or whether these were more generalized effects due to the pandemic, we compared these temporal trends to rates of hospitalizations for inflammatory bowel disease (IBD) and stroke. Results A total of 1,501,415 CDI admissions were identified. The mean age was 64.6 years and 54.2% of patient’s were female. 4.5% of admissions for CDI were associated with in-hospital mortality. Trends in hospitalization are summarized in Figure 1. Compared to the pre-pandemic period (January 2018-December 2019) CDI-related hospitalizations decreased by 9.1%/month [95% CI: -19.2%, +2.0%] (p=0.12) in early 2020 (January-March 2020). This reduction was not sustained: hospitalizations subsequently increased by +8.0% [95% CI: -4.0%, +21.6%] (p=0.19) in mid-2020 (April-June 2020) and were stable after July 2020 (MPC -0.9% [95% CI: -3.5%, +1.7%], p=0.48). Similar patterns were observed for both IBD and stroke-related hospitalizations. Total hospitalizations per month for CDI were similar by June 2020 as compared to the year preceding the pandemic. Conclusions Although an initial decrease in the rates of CDI hospitalizations were seen early in the pandemic (January-March 2020), this pattern was similarly seen for other chronic and acute conditions, and this has not been sustained long-term. Figure 1. Rates of CDI admissions (2018-2020) Funding Agencies None

Clinical outcomes associated with antidepressant use in inflammatory bowel disease patients and a matched control cohort

Antidepressant medications (AMs) are frequently used in inflammatory bowel disease (IBD). Many AMs enhance serotonin (5-HT) availability, but this phenomenon may actually worsen IBD. We hypothesized that use of 5-HT-enhancing AMs would be associated with poor clinical outcomes in these disorders. We performed a retrospective cohort study using the Merative Health Marketscan® commercial claims database between 1/1/05 and 12/31/14. Participants (18–63 years) were either controls or had ≥ 2 ICD-9 diagnoses for IBD with ≥ 1 year of continuous insurance enrollment before index diagnosis and 2 years after. We identified new AM prescriptions using the medication possession ratio. Primary outcomes were corticosteroid use (IBD-only), IBD-related complication (IBD-only), IBD-related surgery (IBD-only), hospitalization, and emergency department (ED) visit(s) within 2 years of diagnosis or starting AM. We calculated adjusted hazard ratios (aHRs) in IBD AM users (for each outcome). We also performed subgroup analyses considering IBD and AM subtype. In the IBD cohort (n = 29,393, 41.4% female; 42.2%CD), 5.2% used AMs. In IBD, AM use was independently associated with corticosteroid use, ED visits, and hospitalizations, but not IBD-related complications. AM use was associated with a decreased risk of surgery. In the control cohort (n = 29,393, 41.4% female), AM use was also independently associated with ED visits and hospitalizations, and there was an increased likelihood of these two outcomes compared to the IBD cohort. In conclusion, while AM use was independently associated with an increased risk of ED visits and hospitalization in IBD, these risks were statistically more common in a matched control cohort. Additionally, AM use was associated with reduced risk of surgery in IBD, demonstrating a potential protective role in this setting.

Clinical service delivery implications of the COVID-19 pandemic on people with Inflammatory bowel disease: a qualitative study

BackgroundDuring the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future.MethodsThis exploratory qualitative study used semi-structured interviews to explore participants’ experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis.ResultsOf the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future.ConclusionsOur findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it’s future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient.

Longitudinal Trends in Pregnancy Outcomes Among Women With Inflammatory Bowel Disease in the Era of Biologics: A 20-Year Nationwide Analysis.

Many women with inflammatory bowel disease (IBD) are diagnosed by their reproductive years. Prior literature suggests that women with IBD may be at increased risk of adverse pregnancy outcomes. Biologics have revolutionized IBD treatment, and current evidence favors continuation during pregnancy. We sought to examine trends in pregnancy outcomes over 20 years with the evolution of IBD treatment. Using the National Inpatient Sample, IBD and non-IBD obstetric hospitalizations were identified between 1998 and 2018 using International Classification of Diseases 9 and 10 codes. Outcomes of interest included cesarean delivery, gestational diabetes, preeclampsia/eclampsia, premature rupture of membranes (PROM), preterm delivery, fetal growth restriction (FGR), fetal distress, and stillbirth. Stratified by Crohn's disease (CD), ulcerative colitis (UC), and non-IBD deliveries, temporal trends and multivariable logistic regression were analyzed. There were 48 986 CD patients, 30 998 UC patients, and 69 963,805 non-IBD patients. Between 1998 and 2018, CD deliveries increased from 3.3 to 12.9 per 10 000 deliveries (P < 0.001) and UC deliveries increased from 2.3 to 8.6 per 10 000 deliveries (P < 0.001). Cesarean deliveries, gestational diabetes, preeclampsia/eclampsia, PROM, FGR, and fetal distress increased over time for IBD and non-IBD women, while preterm deliveries decreased (P < 0.001). Multivariable analyses demonstrated that IBD patients had higher risk of cesarean delivery, preeclampsia/eclampsia, PROM, and preterm delivery compared with non-IBD patients. Over a 20-year period, live deliveries amongst women with IBD have increased. Trends in pregnancy outcomes have followed a similar trajectory in patients with and without IBD. However, there is still demonstrable risk of adverse pregnancy outcomes in patients with IBD.

Characterizing Regionalization of Inflammatory Bowel Disease Hospitalizations and Operations in Washington State

BackgroundHospitalizations for inflammatory bowel disease (IBD) are a major contributor of healthcare utilization. We assessed IBD hospitalizations and surgical operations in Washington State to characterize regionalization patterns. MethodsWe identified a cohort of hospitalizations for Crohn’s disease (CD) or ulcerative colitis (UC) from 2008 to 2019 using Washington State’s Comprehensive Hospital Abstract Reporting System (CHARS). Hospitalizations were characterized by emergent or elective acuity and whether an operation or endoscopic procedure was performed. Facility volume and distance travelled by patients were used to determine regionalization. ResultsThere were 20,494 IBD-related hospitalizations at 95 hospitals: 13,585 (66.3%) with CD and 6,909 (33.7%) with UC. Emergencies accounted for 78.2% of all IBD-related hospitalizations and did not differ between CD (78.3%) and UC (77.9%) (p = 0.54). Surgery was performed during 10.3% and endoscopy during 30.6% of emergent hospitalizations. 72.0% of emergent hospitalizations occurred at 22 facilities, while 71.1% of elective hospitalizations were concentrated at 9 facilities. Operations were performed during 78.5% of elective hospitalizations, and five hospitals performed 69% of all elective surgery. Laparoscopic surgery increased in both emergent (17% to 52%, p < 0.001) and elective operations (18% to 42%, p < 0.001) from 2008 to 2019. ConclusionsIn Washington State, most IBD hospitalizations were emergent, which were decentralized and typically non-operative. By contrast, most elective admissions involved surgery and were centralized at a few high-volume centers. Further understanding the drivers behind IBD hospitalizations may help optimize emergent medical and elective surgical care at a state level.

Trends in hospital admissions and mortality among inflammatory bowel disease patients with substance use disorder: a 10-year United States nationwide analysis

Background Patients with inflammatory bowel disease (IBD) and substance use disorder (SUD) may have worse clinical outcomes. However, data specific to the hospital admission and mortality rates among IBD patients with SUD are scarce. Our objective was to assess trends in admission, healthcare expenses, and mortality for IBD patients with SUD. Methods We conducted a retrospective study using the National Inpatient Sample database to analyze SUD (alcohol, opioids, cocaine, and cannabis) among IBD hospitalizations from 2009 to 2019. Results A total of 132,894 hospitalizations for IBD had a secondary diagnosis of SUD. Of these patients, 75,172 (57%) were men and 57,696 (43%) were women. The IBD-SUD cohort had a longer length of stay than the non-SUD cohort (P < 0.001). The mean inpatient charges for IBD hospitalizations with SUD increased from $48,699 ± $1374 in 2009 to $62,672 ± $1528 in 2019 (P < 0.001). We found a 159.5% increase in IBD hospitalizations with SUD. The hospitalization rate increased from 3492 per 100,000 IBD hospitalizations in 2009 to 9063 per 100,000 in 2019 (P < 0.001). In-hospital mortality for IBD hospitalizations with SUD increased by 129.6% (from 250 deaths per 100,000 IBD hospitalizations in 2009 to 574 deaths per 100,000 IBD hospitalizations in 2019) (P < 0.001). Conclusions Over the last decade, there has been a rise in IBD hospitalizations with SUD. This has resulted in a longer length of stay, higher inpatient charges, and higher mortality rates. Identifying IBD patients potentially at risk for SUD by screening for anxiety, depression, pain, or other factors has become crucial.

A210 THE BURDEN OF IBD HOSPITALIZATION IN CANADA: AN ASSESSMENT OF THE CURRENT AND FUTURE BURDEN IN A NATION-WIDE ANALYSIS

A210 THE BURDEN OF IBD HOSPITALIZATION IN CANADA: AN ASSESSMENT OF THE CURRENT AND FUTURE BURDEN IN A NATION-WIDE ANALYSIS

Disparities and trends in suicidal ideations for inflammatory bowel disease hospitalizations: a decade-long national database analysis

Aim: Patients with inflammatory bowel disease (IBD) are more likely to develop anxiety or depression. The study aimed to describe the trends and disparities of suicidal ideation (SI) in hospitalized IBD patients. Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database, to analyze SI among the IBD hospitalizations from 2009 to 2019. Bivariate analysis was conducted using a chi-square test for categorical variables and an independent t-test for continuous variables. For prevalence, the trend over time was evaluated using the score test. Results: There were 1,724 IBD hospitalizations with SI for the study period. There was a male (53.8%) and white race (74.2%) predominance. The mean age was 41.47 ± 0.25 years. The hospital stay decreased for IBD hospitalizations with SI from 7.97 days in 2009 to 7.57 days in 2019 (P &lt; 0.001). The mean hospital charge increased from $44,664 in 2009 to $66,639 in 2019 (P &lt; 0.001). The prevalence of SIs increased from 0.17% in 2009 to 0.29% in 2019 (P &lt; 0.001). The mean age of these hospitalizations increased from 38 years in 2009 to 42.3 years in 2019 (P = 0.02). The prevalence of generalized anxiety disorder (GAD) increased from &lt; 1% in 2009 to 12.19% in 2019 (P &lt; 0.001). The prevalence of depression increased from 18.04% in 2009 to 51.21% in 2019 (P &lt; 0.001). Inpatient mortality increased from 0% in 2009 to 2.43% in 2019 (P = 0.024). Among IBD hospitalizations, the male gender had a higher association with SIs than females (odds ratio 1.32 [95% confidence intervals (CI) 1.06–1.66], P = 0.014). Conclusions: There is a rise of SI among the IBD population. Specialized protocols should be in place in clinical settings and communities to identify and assess high-risk patients.

Cytomegalovirus Infection Is Associated With Adverse Outcomes Among Hospitalized Pediatric Patients With Inflammatory Bowel Disease.

Adults with inflammatory bowel disease (IBD) are at increased risk of developing cytomegalovirus (CMV) colitis, which is associated with adverse outcomes. Similar studies in pediatric IBD patients are lacking. We analyzed non-overlapping years of National Inpatient Sample (NIS) and Kids Inpatient Database (KID) between 2003 and 2016. We included all patients < 21 years with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). Patients with coexisting CMV infection during that admission were compared with patients without CMV infection for outcome measures such as in-hospital mortality, disease severity, and healthcare resource utilization. We analyzed a total of 254,839 IBD-related hospitalizations. The overall prevalence rate of CMV infection was 0.3% with an overall increasing prevalence trend, P < 0.001. Approximately two-thirds of patients with CMV infection had UC, which was associated with almost 3.6 times increased risk of CMV infection (confidence interval (CI): 3.11 to 4.31, P < 0.001). IBD patients with CMV had more comorbid conditions. CMV infection was significantly associated with increased odds of in-hospital mortality (odds ratio (OR): 3.58; CI: 1.85 to 6.93, P < 0.001) and severe IBD (OR: 3.31; CI: 2.54 to 4.32, P < 0.001). CMV-related IBD hospitalizations had increased length of stay by 9 days while incurring almost $65,000 higher hospitalization charges, P < 0.001. The prevalence of CMV infection is increasing in pediatric IBD patients. CMV infections significantly corelated with increased risk of mortality and severity of IBD leading to prolonged hospital stay and higher hospitalization charges. Further prospective studies are needed to better understand the factors leading to this increasing CMV infection.

P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis

Abstract Background Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia. Methods Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD. Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC). Results Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals. The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient. Conclusion Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.

P239 Incidence of Long COVID and impact of medications on the risk of developing Long COVID in a nationwide cohort of Inflammatory Bowel Disease patients

Abstract Background With the ongoing SARS-CoV-2 pandemic there is concern for development of Long COVID in patients with immune-mediated diseases treated with immunosuppressive agents. We aimed to determine the incidence of Long COVID among Inflammatory Bowel Disease (IBD) patients and to identify associated risk factors. Our study also aimed at studying the differences in risk of Long COVID among different IBD medication exposures. Methods We conducted a retrospective cohort study utilizing a nationwide cohort of patients with IBD in the Veteran Affairs Healthcare System (VAHS). Patients diagnosed with SARS-COV-2 between March 10th, 2020, and January 24th, 2021, were included. All charts were reviewed to determine recent IBD hospitalization, hospitalization for SARS-CoV-2 infection, and stability of IBD control pre and post infection. COVID-19 hospitalizations were also reviewed for intensive care unit requirement (ICU). COVID-19 treatments including remdesivir, monoclonal antibody infusions, and corticosteroids were also ascertained. Primary outcome was development of Long COVID. Cox regression analysis was used to identify variables associated with Long COVID. Results A total of 677 patients with SARS-CoV-2 infection were included, of which 49 (7.3%) were diagnosed with Long COVID (Table 1). No significant differences in IBD medication class between patients with and without Long COVID diagnoses were noted. In multivariable regression analysis, COVID-19 hospitalization (HR 3.56, 95% CI 1.80-7.09, p&amp;lt;0.001), ICU requirement (HR 2.20, 95% CI 1.18-4.08, p=0.01), and COPD (HR 2.41, 95% CI 1.03-5.64, p=0.04) were significantly associated with Long COVID (Table 2). Adjusted survival curves showed that relative to patients who were not hospitalized, patients hospitalized in the ICU had an 8.61-fold increased hazard of Long COVID (HR 8.61, 95% CI 3.98-18.65, p&amp;lt;0.001) (Figure 1). Conclusion Hospitalization and ICU care for COVID-19, as well as pre-existing COPD, were associated with increased risk of developing Long COVID, suggesting that severity of infection with a vulnerable substrate are key drivers of risk. Medications used in the treatment of IBD did not impact the risk of Long COVID. These findings should help reassure and inform IBD patients about the risk of Long COVID.

THE INTERPLAY OF IBD AND DEPRESSION IN INPATIENT LENGTH OF STAY, COST, AND COMPLICATIONS

Abstract BACKGROUND Many patients with inflammatory bowel disease (IBD) also have symptoms of depression. Both IBD and depression are associated with high healthcare utilization. In this cross-sectional study of population-based data, we sought to better characterize the impact of comorbid depression on hospitalizations of IBD patients. METHODS We used the 2016-2018 National Inpatient Sample (NIS) from the United States Department of Health and Human Services to identify hospitalizations with IBD and depression using ICD-10 codes. ICD-10 codes also identified confirmed complications of IBD, such as rectal bleed, fistula, abscess, or intestinal obstruction. Hospitalizations for suicidal intent were excluded from our analysis. Health outcomes including length of stay (LOS), total cost, and complications of IBD were compared between IBD patients with and without depression. Patients with confirmed discharges were captured and survival curves were compared for time to discharge. Statistical analysis was performed using STATA, including two-sample t-testing and logistic regression (significance, p&amp;lt;0.01). RESULTS Over three years, 129,011 hospitalizations for IBD were isolated. Of these, 2,124 hospitalizations (1.65%) were recognized to have both IBD and depression. Lengths of hospitalization for IBD patients with depression were longer than those without (mean LOS [95% CI]: 7.52 [7.06-7.98] vs. 5.28 [5.24-5.32], p&amp;lt;0.001) (Figure 1). Despite this, total cost of hospitalizations for IBD patients with depression was lower compared to IBD patients without depression ($mean [95% CI]: $47,841 [43,720-51,963] vs. $53,544 [53,023-54,065], p=0.008). Additionally, odds of hospitalization with IBD complication were lower in admissions coded for IBD with depression compared to without (OR [95% CI]: 0.52 [0.45, 0.61], p&amp;lt;0.001). On sub-analysis, hospitalizations of IBD patients with depression in partial or full remission had lower length of stay than hospitalizations of IBD with ongoing depression (mean LOS [95% CI]: 4.84 [3.90-5.79] vs. 7.52 [7.06-7.98], p&amp;lt;0.001) (Figure 2). CONCLUSIONS While IBD patients with depression demonstrated lengthier hospitalizations compared to IBD patients without depression, the higher inpatient cost and complications from the latter group may reflect diagnostic, procedural, or surgical management of active disease. While major limitations of this administrative database include identification of hospitalizations instead of individual patients, as well as possibly underreporting or lower recognition of depression during hospitalization, our findings suggest that management of comorbid depression may reduce the length of stay in hospitalized patients with IBD.

Influence of nonalcoholic fatty liver disease on inflammatory bowel disease hospitalizations in the United States.

The reported prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD) is 32%. We assessed the influence of NAFLD on IBD hospitalizations in the United States (US). We utilized the National Inpatient Sample database, from 2016-2019, to identify the total IBD hospitalizations in the US and we further subdivided them according to the presence or absence of NAFLD. Hospitalization characteristics, comorbidities and outcomes were compared. Statistical significance was set at P<0.05. There were 1,272,260 IBD hospitalizations in the US, of which 5.04% involved NAFLD. For IBD hospitalizations with NAFLD, the mean age was 50-64 years, and the proportion of males was 46.97%. IBD hospitalizations with NAFLD had a lower proportion of African Americans (8.7% vs. 11.38%, P<0.001). Comorbidities such as hypertension (50.34% vs. 44.04%, P<0.001) and obesity (18.77% vs. 11.81%, P<0.001) were significantly higher in the NAFLD cohort. Overall, based on the Charlson Comorbidity Index, patients with NAFLD had a higher number of comorbidities (52.77% vs. 20.66%, P<0.001). Mortality was higher in the NAFLD compared to the non-NAFLD cohort (3.14% vs. 1.44%, P<0.001). Patients with NAFLD also incurred significantly higher hospital charges ($69,536 vs. $55,467, p<0.001) and had a longer mean length of stay (6.10 vs. 5.27 days, P<0.001) compared to the cohort without NAFLD. Complications and inpatient procedure requirements were also higher in the NAFLD cohort. Our study revealed greater mortality, morbidity, and healthcare resource utilization in patients with IBD who were hospitalized with a concomitant diagnosis of NAFLD.

Application of Procalcitonin for the Rapid Diagnosis of Clostridioides difficile Infection in Patients with Inflammatory Bowel Disease.

Background: The incidence of Clostridioides difficile infection (CDI) has increased in recent years in patients with inflammatory bowel disease (IBD). C. difficile is a toxin-producing bacterium, and CDI results in the worsening of underlying IBD, increasing the risk of IBD treatment failure, surgery, and hospitalization. Because the symptoms of CDI overlap with those of IBD, it is challenging to make a differential diagnosis. Therefore, early, rapid, and reliable diagnostic tools that can identify CDI in IBD patients would be valuable to clinicians. Methods: This study retrospectively collected 135 patients with IBD. Among them, 44 patients were diagnosed with CDI, and 42 patients were diagnosed with viral or fungal infections. A total of 49 patients without infections were defined as the control group. The diagnostic values of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count in the peripheral blood were examined. Results: In this study, PCT levels were significantly higher in patients with CDI than in non-CDI patients (including patients with viral/fungal infections and the control group; p &lt; 0.001 and p &lt; 0.05, respectively). CRP levels were significantly higher in patients with CDI than in non-CDI patients (p &lt; 0.05). The area under the curve (AUC) of PCT and WBC count were compared using DeLong's test: the AUCs of PCT vs. CRP for the detection of the IBD-CDI group and the control group was 0.826 [95% confidence interval (CI) 0.743-0.909] vs. 0.663 [95% confidence interval (CI) 0.551-0.774] (p &lt; 0.05), respectively. WBC count was inferior as a diagnostic tool for CDI. The sensitivity was 59.09% (95% CI: 43.2% to 73.7%), the specificity was 89.80% (95% CI: 77.8% to 96.6%), and the positive likelihood ratio LR (+) was 5.79 for PCT for the diagnosis of CDI. Conclusions: The present study demonstrates the superiority of PCT over CRP and WBC count for the rapid diagnosis of CDI in IBD patients.

S5 Characteristics and Outcomes of Patients With IBD Admitted to High vs Low Safety Net Burden Hospitals: A Nationwide Analysis

Background: Inflammatory bowel disease (IBD), is a chronic relapsing inflammatory disorder that requires a meticulous multidisciplinary management approach. This may prove difficult in safety net hospitals, and it is unclear if a hospital’s safety net burden (SNB) is associated with outcomes. The aim of this study was to investigate the effect of hospital SNB on in-hospital mortality, length of stay, and hospitalization cost in patients with IBD. Methods: We used the National Inpatient Sample (NIS) to identify all adult hospitalizations with IBD from 2016 to 2018. SNB was calculated as the percentage of hospitalizations with Medicaid or uninsured payer status for each hospital in the 2016-2018 database. Multivariable models were used to compare outcomes of admissions to hospitals with low SNB (lowest tertile, <18.1%) hospitals with high SNB (highest tertile, >31.1%). Results: The demographic and clinical characteristics for the 106,603 patients hospitalized with IBD are shown in Table 1 (see poster). Of all patients, 42.3% were admitted to low SNB hospitals and 57.7% were admitted to high SNB hospitals. The main study outcomes (in-hospital mortality, length of stay, and cost) are shown in Table 2 (see poster). In-hospital mortality was 1.4% in low SNB hospitals and 1.6% in high SNB hospitals (adjusted OR = 1.15, 95% CI 1.03-1.29, P = 0.016). Mean length of stay was longer in high SNB hospitals compared to low SNB hospitals (5.6 vs 5.1 days, adjusted mean difference 0.38 days, P < 0.0001). Low SNB hospitals had higher hospitalization costs compared to high SNB hospitals ($15,968 vs $15,670, adjusted mean difference $402, P = 0.01). Conclusion(s): In this large population of inpatients with IBD, patients admitted to high SNB hospitals had overall worse hospital mortality and longer length of stay. Patients admitted to low SNB hospitals had higher hospital costs. Further research is needed to clarify the cause of these discrepant outcomes in IBD hospitalizations, and specific interventions are needed to improve the delivery of care to IBD patients in high SNB hospitals.

S1043 Tofacitinib for the Treatment of Pouch-Related Disorders: A Case Series

S1043 Tofacitinib for the Treatment of Pouch-Related Disorders: A Case Series

S901 Rural versus Urban Differences in Inflammatory Bowel Disease (IBD) Hospitalizations: An Analysis of the National Inpatient Sample (NIS)

Introduction: Inflammatory bowel disease (IBD) is a significant cause of adult hospitalizations in the United States. There are fundamental differences in demographic distribution, socioeconomic status, access to care, and healthcare infrastructure between rural and urban areas in the US. However, very limited data evaluating these differences is available. The study aims to compare outcomes of IBD patients in these two different settings and explore the causes for any observed differences. Methods: Data obtained from the national inpatient sample (NIS) 2016–2019 database was evaluated for IBD admissions in rural and urban hospitals of the US. The primary outcome assessed was inpatient mortality, while secondary outcomes included odds of developing bowel perforation, septic shock, perianal disease, need for RBC transfusion, total hospital charges (THC), and length of stay (LOS). Results: A total of 348,469 adult IBD hospitalizations occurred during the study period. Out of this number, 24,044 patients were managed in rural settings, while 324,425 patients were managed in urban settings. The mean age of rural IBD patients was 48 years old while it was 44 years old in urban areas. Rural IBD patients had shorter inpatient LOS (3.94 days vs 5.03 days, p< 0.001) and THC ($24,515 vs $48,754, p< 0.001) than urban IBD patients. There was no difference between patient groups regarding inpatient mortality, developing septic shock, bowel perforation, need for RBC transfusion, and odds of developing perianal disease. Conclusion: The current study indicates most IBD care variables assessed between rural/urban settings were not different. However, differences were observed in LOS and THC between rural and urban IBD patients. The high cost of health care in urban settings most likely contributed to observed differences in the THC due to advanced treatments not being readily available in the rural environment. Increased access to subspecialist practices more comforTable with IBD patient care in urban areas also may contribute to a prolonged LOS as they likely deal with more medically complex patients who require advanced diagnostic testing not available at rural institutions. Improved understanding of rural/urban IBD patient severity variations and care access/availability are needed to accurately ascertain the reason behind these differences.

S813 Venous Thromboembolism Rates Among Patients Hospitalized for Inflammatory Bowel Disease Exacerbation: A Time Trend Analysis of the National Inpatient Sample

Introduction: Inflammatory bowel disease (IBD) flare increases risk of venous thromboembolism (VTE) events, especially during hospitalization. Guidelines, support the use of VTE prophylaxis for these patients, but it is unclear if this has impacted rates of VTE. Our goal was to assess time trends of VTE rates among IBD admissions. Methods: Patients hospitalized from 2007 to 2019 were identified in the National Inpatient Sample (NIS) by International Classification of Diseases (ICD), 9th and 10th Revision codes. Patients with IBD flare were selected by either a) a primary diagnosis of Crohn’s disease (CD) or Ulcerative colitis (UC) or b) a secondary diagnosis of CD or UC with a primary diagnosis of a gastrointestinal manifestations of IBD: abdominal pain, anemia, malnutrition, or dehydration. Hospitalizations for VTE were identified by those with a primary or secondary diagnosis of VTE. Patients with chronic thrombosis or prior VTE were excluded. Incidence of VTE was assessed by disease type (CD vs. UC) and by racial/ethnic identification: white, black, Hispanic, Asian or Pacific Islander, Native American, other. Cochran-Armitage trend tests were used for binary variables while trends for variables with reported mean averages used linear regression. The Rao-Scott design-adjusted chi-square test was used to evaluate the association between binary variables and the diagnosis of IBD in patients with VTE. Results: 131,541 weighted cases were admitted for an IBD flare complicated by VTE; 73,530 had CD and 58,011 had UC, Table. VTE prevalence was higher among patients with UC compared to CD, 42.6 vs. 30.7 per 1,000 hospitalizations, respectively. Over the study period, the rates of VTE in IBD hospitalizations increased, from 3.58% to 4.62% for UC (p< 0.0001) and from 2.22% to 3.66% for CD (p< 0.0001), Figure 1a. Black patients with IBD were found to be at higher risk of VTE (aOR 1.075, p=0.002), while Hispanic and Asian / Pacific Islanders had lower risk for developing VTE when compared to Whites (aOR 0.873 and 0.658, respectively; p< 0.0001). Aside from Hispanic and Native American UC patients, all races and ethnicities had increasing trends of VTE during the study period, Figure 1b, 1c. Conclusion: IBD admissions complicated by VTE have significantly increased. Though increasing awareness of VTE with IBD flare may have resulted in additional diagnoses, the study findings suggest that current VTE prophylaxis, or utilization of VTE prophylaxis, may be inadequate for those hospitalized for IBD flare.Figure 1.: VTE rates as % of total IBD hospitalizations per year. Table 1. - Patient Demographics and Hospital Characteristics of IBD Patients Admitted with VTE Variable Crohn's Disease (n=73,530) Ulcerative Colitis (n=58,011) Age in years [Mean(SD)] 56 (0.16) 60 (0.19) Sex Male 43.7% 50.3% Female 56.3% 49.7% Race* White 81.1% 79.6% Black 12.3% 10.4% Hispanic 3.8% 6.1% Asian / Pacific Islander 0.5% 1.1% Native American 0.4% 0.4% Other 1.9% 2.5% Insurance Type Medicare 48.5% 48.9% Medicaid 12.5% 8.8% Private Insurance 32.7% 36.4% Self-Pay 3.2% 2.8% Other 3.1% 3.1% Hospital Bed Size Small 13.8% 13.5% Medium 25.1% 24.8% Large 61.1% 61.7% Hospital Location/ Type Rural 7.2% 6.1% Urban Nonteaching 28.0% 28.9% Urban Teaching 64.8% 65.0% Charlson Comorbidity Index CCI = 0 36.4% 35.5% CCI = 1 21.8% 21.3% CCI = 2 15.5% 14.7% CCI ≥ 3 26.3% 28.6% Hospitalization Cost $95,500 $110,473 Length of Stay (in mean days) 10.39 11.25 Death (per 1,000 hospitalizations) 41.8 61.4 *There were some charts where race was documented in NIS as unknown.