Inflammatory Bowel Disease Hospitalizations Research Articles

S1063 Corticosteroid Use in Inflammatory Bowel Disease (IBD) Patients May Lead to Worse IBD-Related Outcomes After COVID-19 Infection

Introduction: There is growing but limited data on the effects COVID-19 has on the disease course of IBD. COVID-19 can enter epithelial cells of the gut via ACE receptors causing cell dysfunction, inflammation, and dysbiosis. Thus, we set out to evaluate IBD outcomes during and three months after COVID-19 infection. Methods: We performed a retrospective case series comparing IBD patients in remission versus not in remission diagnosed with COVID-19 seen in a single tertiary care center from March 2020 to March 2021. COVID-19 diagnosis was made by positive rapid antigen and/or PCR. We analyzed demographics, medications, need for hospitalization, changes to immunosuppressive therapy, and IBD severity and remission status noted by endoscopic scoring or Physician Global Assessment at the time of COVID-19 diagnosis and 3 months post infection. Results: We identified 57 IBD patients, 30 in remission and 27 not in remission, diagnosed with COVID-19. Comparison of baseline characteristics and COVID-19 and IBD related outcomes are noted in Table. Patients not in remission were more likely to be on steroids, including prednisone and budesonide, and biologics (0% vs 40.7%, p=0.00001; 73.3% vs 96.3%, p=0.03). Patients not in remission were significantly more likely to need escalation in treatment (OR 15.08; CI 2.98-76.3, p=0.001) and had more IBD related hospitalization and surgery at 3 months compared to patients in remission (18.5% vs 0%, p=0.02). We then excluded patients who had changes in IBD medications 90 days prior to COVID-19 diagnosis and found there was still an increased risk for treatment escalation (OR 7, CI 1.27-38.58, p=0.0254). Additionally, patients not in remission on steroids had an increased risk of escalation of IBD related medications, hospitalization, and surgeries than patients not in remission who were not on steroids (OR 12, CI 1.76-81.7, p=0.0111). Conclusion: Our study suggests COVID-19 likely has minimal impact on the clinical course of IBD patients in remission. It remains unclear what the effects are on those not in remission, especially those on corticosteroids. Corticosteroid use is associated with impaired immune response and may lead to dysbiosis by downregulation of protective mucin gene expression as shown in animal models. Thus, infection with COVID-19 in patients on steroids may contribute to an increased risk of dysbiosis and subsequent disease flare. Further study is warranted to study the effects of steroids on IBD related outcomes in patient with COVID-19 infection. Table 1. - Comparison of IBD related outcomes in patients in remission versus those with active disease at time of COVID-19 diagnosis and 3 months afterwards Remission (SD)N = 30 Not in remission (SD)N = 27 P-value Demographics Age 40.2 (16.3) 35.3 (13.7) 0.25 Sex Male 46.7% 33.3% 0.42 Female 53.3% 66.7% 0.42 Race White 70% 74% 0.78 Black 20% 18.5% 1.00 Asian 10% 3.7% 0.61 Hispanic 0% 3.7% 0.47 BMI 26.2 (5.6) 24.8 (4.0) 0.36 Comorbidities Organ transplant 3.3% 7.4% 0.60 Cardiovascular disease 13.3% 11.1% 1.00 Diabetes 3.3% 3.7% 1.00 Chronic lung disease 0% 3.7% 0.47 HTN 10% 7.4% 1.00 Current malignancy 3.3% 0% 1.00 CKD 3.3% 7.4% 0.60 Tobacco use 3.3% 3.7% 1.00 Chronic liver disease 20% 14.8% 0.73 IBD Characteristics Crohn's disease 73.3% 63.0% 0.57 Ulcerative colitis 26.7% 37% 0.57 Activity Mild Moderate Severe 14.8%77.8%7.4% IBD medication use None 6.7% 0% 0.49 5-ASA 23.3% 14.8% 0.51 Immunomodulator 6MP/AZA 3.3% 11.1% 0.34 MTX 10% 7.4% 1.00 Corticosteroids 0% 40.7% 0.00001 Budesonide 0% 18.5% 0.02 Prednisone 0% 22.2% 0.01 Biologics 73.3% 96.3% 0.03 Vedolizumab 16.7% 22.2% 0.74 Anti-TNF 43.3% 51.9% 0.60 Ustekinumab 13.3% 22.2% 0.49 Tofacitinib 0% 0% 1.00 COVID-19 Outcomes Hospitalization 13.3% 7.4% 0.67 ICU with intubation 0% 0% 1.00 Any COVID-19 therapy 3.3% 14.8% 0.18 Death 0% 0% 1.00 IBD medications held 13.3% 29.6% 0.13 IBD Outcomes at 3 months Experienced IBD flare 10% 51.8% 0.005 Escalation of immunosuppression 10% 44.4% 0.00319 Initiation of new steroid therapy 6.7% 22.2% 0.19 IBD related hospitalization/surgery 0% 18.5% 0.02

Thromboembolic Events in Patients with Inflammatory Bowel Disease: A Comprehensive Overview.

Inflammatory bowel disease (IBD), Crohn’s disease and ulcerative colitis are chronic inflammatory disorders of the intestines. The underlying inflammation activates the coagulation cascade leading to an increased risk of developing arterial and venous thromboembolic events such as deep vein thrombosis and pulmonary embolism. Patients with IBD are at a 2–3-fold increased risk of developing thromboembolism. This risk increases in patients with active IBD disease, flare-ups, surgery, steroid treatment, and hospitalization. These complications are associated with significant morbidity and mortality making them important in clinical practice. Clinicians should consider the increased risk of thromboembolic events in patients with IBD and manage them with appropriate prophylaxis based on the risk. In this review, we discuss the literature associated with the pathophysiology of thromboembolism in patients with IBD, summarize the studies describing the various thromboembolic events, and the management of thromboembolism in patients with IBD.

Clinical procedures used to diagnose inflammatory bowel disease: real-world evidence from a Danish nationwide population-based study

ObjectiveAlthough clinical guidelines exist, the diagnostic work-up for diagnosing inflammatory bowel disease (IBD) is complex and varies in clinical practice. This study used real-life data to characterise the current diagnostic...

Abstract 197: Racial Disparity In Major Adverse Cardiovascular Events In Patients With History Of Inflammatory Bowel Disease: Analysis From The National Inpatient Sample

Objective: We aimed to uncover gender and racial differences in major adverse cardiovascular events (MACE) in patients with inflammatory bowel disease (IBD). Methods: The National Inpatient Sample was retrospectively studied (1/1/19-12/31/19) for IBD hospitalizations of ages >17 years. The primary outcome was a composite 5 point-MACE: cerebrovascular accident (CVA), myocardial infarction (STEMI and NSTEMI), congestive heart failure (CHF), Hypertension (HTN), and peripheral arterial disease (PAD). Type of coronary revascularization was assessed: percutaneous intervention (PCI) or coronary artery bypass graft (CABG). Data were analyzed in STATA 16.0, and adjusted odds ratios (AOR) were calculated using hierarchal multivariate regression analysis reported with 95% confidence interval (CI) and P-values. Results: The study included 169,355 patients (females=78705). Caucasians were the predominant race ([78%] reference) followed by African Americans (AA) (11%), Hispanics (H) (7%), and others (4%). Analyses revealed decreased association of STEMI (AOR 0.56, [0.35-0.90], P < 0.001), NSTEMI (AOR 0.53, [0.31-0.92], P < 0.001), CABG (AOR 0.12, [0.01-0.90], P < 0.001) and PAD (AOR 0.76, [0.65-0.89], P < 0.001) in AA vs Caucasians. Concurrently, there was an increased association of CHF (AOR 1.63, [1.43 -1.86], P < 0.001) and HTN (AOR 2.1, [1.88-2.24], P < 0.001) in the AA cohort. No significant difference existed between Hispanics and Caucasians for risk of MACE. Subgroup analysis for ulcerative colitis revealed a decreased occurrence of CABG (P < 0.001) and an increased association of HTN, PAD, and CHF in AA cohort (P < 0.001). Subgroup analysis for Crohn's disease revealed an increased association between HTN and CHF in AA vs Caucasians (P < 0.001). Subgroup analysis for females revealed a decreased association of STEMI and NSTEMI in AA cohort (P< 0.001) and an increased association of HTN, PAD, and CHF (P < 0.001) compared to Caucasians. Conclusion: African American patients with IBD are more likely to develop HTN, PAD, and CHF compared to their Caucasian counterparts while the occurrence of STEMI, NSTEMI, and CABG is reduced. There was no statistically significant change noted in outcomes in the Hispanic population.

Impact of biologics and small molecules for inflammatory bowel disease on COVID-19-related hospitalization and mortality: A systematic review and meta-analysis.

Background and AimThe use of biologics and small molecules has been a concern for patients with inflammatory bowel disease (IBD) during the COVID‐19 pandemic. We aimed to assess the association between the risk of COVID‐19‐related hospitalization and these agents.MethodsWe made a systematic review and meta‐analysis of all published studies from December 2019 to September 2021 to identify studies that reported COVID‐19‐related hospitalization in IBD patients receiving biologic therapies or tofacitinib. We calculated the risk ratio (RR) to compare the relative risk of COVID‐19‐related hospitalization in patients receiving these medications to those who were not, at the time of the study.ResultsEighteen studies were included. The relative risk of hospitalization was significantly lower in patients with IBD and COVID‐19 who were receiving biologic therapy (RR = 0.47 [95% confidence interval, CI: 0.42–0.52, P < 0.00001]) compared to patients not receiving biologics. The RR was lower in patients receiving anti‐tumor necrosis factors (TNFs) compared to those who were not (RR = 0.48 [95% CI: 0.41–0.55, P < 0.00001]). A similar finding was observed in patients taking ustekinumab (RR = 0.55 [95% CI: 0.43–0.72, P < 0.00001]). Combination therapy involving anti‐TNF and an immunomodulator did not lower the risk of COVID‐19‐related hospitalization (RR = 0.98 [95% CI: 0.82–1.18, P = 0.84]). The use of vedolizumab (RR = 1.13 [95% CI: 0.75–1.73, P = 0.56]) or tofacitinib (RR = 0.81 [95% CI: 0.49–1.33, P = 0.40]) was not associated with a lower risk of COVID‐19‐related hospitalization.ConclusionRegarding COVID‐19‐related hospitalization in IBD, anti‐TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID‐19‐related hospitalization.

Short-Term COVID-19 Pandemic-Related Endoscopy Delays Did Not Translate to Deleterious Outcomes for Patients With Inflammatory Bowel Disease: A Retrospective Cohort Study.

BackgroundThe management of inflammatory bowel disease (IBD) requires frequent endoscopic assessment. It is unknown if measures put in place to reduce the spread of the virus SARS-CoV-2, including the delay of non-urgent patient assessments, resulted in deleterious outcomes for patients with IBD. Therefore, we aimed to determine if delays in endoscopy during the COVID-19 pandemic were associated with an increased risk of adverse IBD outcomes (emergency room, ER presentation, hospitalization, surgery, or escalation of drug therapy).MethodsA retrospective cohort study was performed in patients with IBD scheduled for outpatient endoscopies between March and August 2019 and 2020 at two tertiary care centers affiliated with Western University, London, Canada. Data pertaining to endoscopy timing, IBD drug prescription, ER attendance, hospitalization, and surgery were collected.ResultsA total of 1160 endoscopies (2019, n = 718; 2020, n = 442) occurred during the study periods in 669 (2019) and 414 (2020) patients with IBD, respectively. More endoscopies were delayed in 2020 than 2019 (26.7% vs. 9.7%, respectively, P < 0.0001). Endoscopy delay was not associated with an increased risk of an adverse IBD outcome (OR = 1.23, 95%CI = 0.89–1.34, P = 0.20). Fewer adverse IBD outcomes were seen in the 2020 cohort who had endoscopy delays (n = 33/115, 28.7%) versus those without delay (n = 176/299, 58.9%, P < 0.0001).ConclusionMore endoscopy delays occurred during the COVID-19 pandemic; however, delays in general were not associated with adverse IBD outcomes, and in particular, endoscopy delays during the COVID-19 pandemic were associated with fewer deleterious IBD outcomes, suggesting that patients with IBD in need of urgent endoscopy were appropriately identified.

SARS-CoV-2 in inflammatory bowel disease population: Antibodies, disease and correlation with therapy.

BACKGROUNDGuidelines recommend to cease inflammatory bowel disease (IBD) biologic therapy during coronavirus disease 2019 (COVID-19).AIMTo investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody positivity in an IBD cohort, COVID-19 disease severity and to evaluate the correlation with clinical/therapeutic variables.METHODSProspective observational cohort study. IBD patients were tested for SARS-CoV-2 IgG. Data on COVID-19 disease, demographics/therapeutics and clinical features of the IBD population were collected. IgG ≥ 7 was set for SARS-CoV-2 antibody positivity. Throat swab was performed in cases of IgG positivity. Correlations between antibody positivity or COVID-19 symptoms and therapeutic/clinical data were assessed.RESULTSIn total, 103 IBD patients were enrolled. Among them, 18.4% had IgG ≥ 7. Multivariate analysis of antibody positivity correlated only with IBD treatment. For IgG ≥ 7, the odds ratio was 1.44 and 0.16 for azathioprine and mesalazine, respectively, vs biologic drugs (P = 0.0157 between them). COVID-19 related symptoms were reported in 63% of patients with IgG positivity. All but one patient with COVID-19 symptoms did not require ceasing IBD treatment or hospitalization. IBD treatment and body mass index correlated with COVID-19 disease development with symptoms.CONCLUSIONThe IBD population does not have a higher risk of severe COVID-19. The relative risk of having SARS-CoV-2 antibodies and symptoms was higher for patients taking azathioprine, then biologic therapy and lastly mesalazine. None of the patients under biologic therapy developed severe COVID-19.

Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection.

Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.

SAFETY AND EFFECTIVENESS OF THE BNT162B2 MRNA COVID-19 VACCINE IN A NATIONWIDE COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE

BACKGROUND & AIMSThe effectiveness of currently available SARS-CoV-2 vaccines in patients with inflammatory bowel disease (IBD) remains unknown. We aimed to determine the effectiveness of the Pfizer-BNT162b2 mRNA vaccine in a nationwide cohort of patients with IBD in Qatar.METHODSUsing a cohort design, we compared 476 IBD patients vaccinated identified between January 1, 2021, and March 31, 2021, with 476 matched unvaccinated controls (matched on age and date of SARS-CoV-2 testing). Study outcomes included documented SARS-CoV-2 infection, symptomatic COVID-19, and COVID-19 related hospitalization. We also studied the side effects of the vaccination, including the effect on IBD exacerbation and hospitalizations related to adverse events.RESULTSTotal follow-up was 23,289 person-days for the vaccinated and 23,653 person-days for the unvaccinated group. Vaccine effectiveness >14 days [AAB1] after the second dose was 85.1% (95% CI: 65.2, 93.6) for confirmed infection, and 87.1% (95% CI: 63.6, 95.4)[AAB2] for symptomatic infection. No patient required hospitalization >14 days after the second vaccine dose. Estimated vaccine effectiveness between 22 to 35 days after the first dose was 14.8% (95% CI: -151.5, 71.2) [AAB3] for any documented infection, and 59.8% (95% CI: -106.1, 92.2) for symptomatic COVID-19 disease. For patients taking biologics with or without immunomodulators, vaccine effectiveness >14 days after the second dose was 94% (95% CI: 53.1, 99.2), and 92.7% (95% CI: 45.1, 99.0) for any documented infection and symptomatic COVID-19 respectively. Vaccine effectiveness was 87.4% (95% CI: 46.0, 97.1) for any documented infection and 91.7% (95% CI: 37.2, 98.9) for symptomatic COVID-19 during the same period for patients taking immunomodulators alone. None of the vaccinated patients required intensive care unit admission or died. No patient had IBD exacerbation or required hospitalization for vaccination-related adverse events.CONCLUSIONIn a nationwide cohort of IBD patients, the BNT162b2 mRNA vaccine was safe and highly effective.

P568 Impact of Biologics and Small Molecules for Inflammatory Bowel Disease on COVID-19 Related Hospitalization: A Systematic Review and Meta-analysis

BackgroundThe use of biological therapies and small molecules have been a concern for patients with inflammatory bowel disease (IBD) during COVID-19 pandemic. We aim to assess the association between risk of COVID-19 related hospitalization and these agents.MethodsA systematic review and meta-analysis of all published studies from December 2019 to September 2021 was performed to identify studies that reported COVID-19 related hospitalization in IBD patients receiving biological therapies or tofacitinib. The risk ratio (RR) was calculated to compare the relative risk of COVID-19 related hospitalization in patients receiving these medications to those who were not, at the time of the study.Results18 studies were included. The relative risk of hospitalization was significantly lower in patients with IBD and COVID-19 who were receiving biologic therapy with RR of 0.47 (95% CI: 0.42–0.52, p < 0.00001). The RR was lower in patients receiving anti-TNFs compared to those who did not [RR= 0.48 (95% CI: 0.41–0.55, p < 0.00001)]. Similar finding was observed in patients taking ustekinumab [RR= 0.55 (95% CI: 0.43–0.72, p < 0.00001)]. Combination therapy of anti-TNF and an immunomodulator did not lower the risk of COVID-19 related hospitalization [RR= 0.98 (95% CI: 0.82–1.18, p =0.84]. The use of vedolizumab [RR= 1.13 (95% CI: 0.75–1.73, p =0.56] and tofacitinib [RR= 0.81 (95% CI: 0.49–1.33, p =0.40] was not associated with lower risk of COVID-19 related hospitalization.ConclusionRegarding COVID-19 related hospitalization in IBD, anti-TNFs and ustekinumab were associated with decreased risk of hospitalization. In addition, vedolizumab and tofacitinib were not associated with COVID-19 related hospitalization.

DOP04 Inflammatory Bowel Disease (IBD) and Solid Organ Transplantation. Natural history of pre-existing and de novo IBD patients. (EITOS study of GETECCU)

Abstract Background Limited data is available of the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). The aim of our study was to describe the natural history of pre-existing IBD and de novo IBD after SOT. Methods A retrospective, observational, multi-centre, nationwide study was designed. IBD patients with SOT were included. We identified two separate cohorts: (1) patients with pre-existing IBD at the time of SOT and (2) patients without IBD at the time of SOT (de novo IBD). The primary outcome was IBD progression, defined by the escalation of medical treatment, surgical therapy for medically refractory IBD or IBD-related hospitalization during follow-up. Risk factors were identified using multivariate Cox proportional hazard analysis. Results A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) from 31 centres were included. Baseline characteristics are shown in Table 1. Eighty-six patients with IBD and SOT underwent liver transplantation, while 82 required renal, 4 lung, 3 heart, 1 liver/kidney and 1 pancreas/kidney transplantation. Pre-existing IBD patients were followed-up over a median of 4.8 years (range 2.6–9.4). At the time of SOT, 61 patients (59.8%) were not under maintenance treatment or were treated with 5-aminosalicylates, 10 (9.8%) were on immunosuppressive therapy and 31 (30.4%) were receiving biological agents, of which 8 were on combo therapy. At the moment of SOT, only 8 patients (7.5%) had moderate IBD activity whereas the remaining patients were in remission. During follow-up 33.7% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 years (range 1.3–4.6). No differences between Crohn′s disease and ulcerative colitis were found (Figure 1). The median time of follow-up in de novo IBD group was 5.1 years (range 2.1–8.2). In this cohort, 55.9% of patients had disease progression during follow-up (Figure 2), with a median time to flare of 1.9 years (range 0.8–3.9) from diagnosis. In pre-existing IBD cohort, multivariate Cox-regression analysis identified active IBD at the time of SOT (HR=1.80; 95%CI: 1.14–2.84; p=0.012) and the presence of extraintestinal manifestations (HR=3.10; 95%CI: 1.47–6.54; p=0.003) as predictive factors of IBD progression after SOT. Conclusion One third of patients with pre-existing IBD have disease progression, needing medical therapy escalation, surgery or hospitalization after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for disease progression. In de novo IBD cohort, about half of patients showed disease progression during follow-up.

SAFETY AND EFFECTIVENESS OF THE BNT162B2 MRNA COVID-19 VACCINE IN A NATIONWIDE COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE

The effectiveness of currently available SARS-CoV-2 vaccines in patients with inflammatory bowel disease (IBD) remains unknown. We aimed to determine the effectiveness of the Pfizer-BNT162b2 mRNA vaccine in a nationwide cohort of patients with IBD in Qatar. Using a cohort design, we compared 476 IBD patients vaccinated identified between January 1, 2021, and March 31, 2021, with 476 matched unvaccinated controls (matched on age and date of SARS-CoV-2 testing). Study outcomes included documented SARS-CoV-2 infection, symptomatic COVID-19, and COVID-19 related hospitalization. We also studied the side effects of the vaccination, including the effect on IBD exacerbation and hospitalizations related to adverse events. Total follow-up was 23,289 person-days for the vaccinated and 23,653 person-days for the unvaccinated group. Vaccine effectiveness >14 days [AAB1] after the second dose was 85.1% (95% CI: 65.2, 93.6) for confirmed infection, and 87.1% (95% CI: 63.6, 95.4)[AAB2] for symptomatic infection. No patient required hospitalization >14 days after the second vaccine dose. Estimated vaccine effectiveness between 22 to 35 days after the first dose was 14.8% (95% CI: -151.5, 71.2) [AAB3] for any documented infection, and 59.8% (95% CI: -106.1, 92.2) for symptomatic COVID-19 disease. For patients taking biologics with or without immunomodulators, vaccine effectiveness >14 days after the second dose was 94% (95% CI: 53.1, 99.2), and 92.7% (95% CI: 45.1, 99.0) for any documented infection and symptomatic COVID-19 respectively. Vaccine effectiveness was 87.4% (95% CI: 46.0, 97.1) for any documented infection and 91.7% (95% CI: 37.2, 98.9) for symptomatic COVID-19 during the same period for patients taking immunomodulators alone. None of the vaccinated patients required intensive care unit admission or died. No patient had IBD exacerbation or required hospitalization for vaccination-related adverse events. In a nationwide cohort of IBD patients, the BNT162b2 mRNA vaccine was safe and highly effective.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil.

BACKGROUNDInflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The introduction of biologic drugs into the therapeutic arsenal in the last two decades, combined with an expansion of immunosuppressant therapy, has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality (IHM) due to IBD.AIMTo describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.METHODSThis observational, retrospective, ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM. Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses. The following variables were analyzed: Number of deaths and hospitalizations, length of hospital stay, financial costs of hospitalization, sex, age, ethnicity and type of hospital admission.RESULTSThere was a reduction in the number of IBD hospitalizations, from 6975 admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R2 = 0.8197; P < 0.0001). The hospitalization rate also decreased, from 3.60/100000 in 2000 to 2.17 in 2010. IHM rates varied during the 20-year period, between 2.06 in 2017 and 3.64 in 2007, and did not follow a linear trend (y = -0.0005049x + 2.617; R2 = 0,00006; P = 0.9741). IHM rates also varied between regions, increasing in all but the southeast, which showed a decreasing trend (y = -0.1122x + 4.427; R2 = 0,728; P < 0.0001). The Southeast region accounted for 44.29% of all hospitalizations. The Northeast region had the highest IHM rate (2.86 deaths/100 admissions), with an increasing trend (y = 0.1105x + 1.110; R2 = 0.6265; P < 0.0001), but the lowest hospitalization rate (1.15). The Midwest and South regions had the highest hospitalization rates (3.27 and 3.17, respectively). A higher IHM rate was observed for nonelective admissions (2.88), which accounted for 81% of IBD hospitalizations. The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5% compared to 2008.CONCLUSIONThere has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. IHM rates varied and did not follow a linear trend.

Substance abuse and inpatient outcomes in inflammatory bowel disease hospitalizations in the United States: a propensity matched analysis.

Inflammatory bowel disease (IBD) is a chronic intestinal inflammation resulting in a genetically susceptible population. The present study aimed to look at the effect of substance abuse on IBD hospitalizations in the United States. We identified primary IBD hospitalizations with substance abuse using the National Inpatient Sample database (2016-2019). A matched comparison cohort of IBD hospitalizations without substance abuse was identified by 1:N propensity score matching using the nearest-neighbor method, based on demographics, hospital-level factors, and comorbidities. We matched 4437 IBD hospitalizations with a diagnosis of substance abuse to 4528 hospitalizations without abuse. The median age was higher in the substance abuse group than no abuse (44 vs. 38 years, P<0.001). There was a higher prevalence of discharge to care facilities (2.9% vs. 2.2%) and against medical advice (4.9% vs. 1.8%) in the substance abuse group compared to the no abuse (P<0.001). The median length of hospital stays (LOS) (P=0.74) and hospitalization charge did not differ significantly (P=0.57). There was no significant difference in 30-day inpatient mortality among cohorts (adjusted hazard ratio 0.74, 95% confidence interval 0.32-1.81; P=0.54). There was a higher prevalence of psychoses (2.5% vs. 1.3%) and depression (18.8% vs. 15.7%) in IBD hospitalizations with substance abuse compared to those without abuse (P<0.001). This study reports no difference in median LOS, hospitalization charge, or mortality risk in IBD hospitalizations based on substance abuse. There is a higher prevalence of psychoses and depression in IBD patients, requiring screening for substance abuse to improve overall outcomes.

Outcomes of COVID-19 in Patients with Inflammatory Bowel Disease: Comparison with Household Members and the Role of IBD Medications.

Most data on the effect of inflammatory bowel disease (IBD) and its treatments on coronavirus disease 2019 (COVID-19) outcomes have not had non-IBD comparators. Hence, we aimed to describe COVID-19 outcomes in IBD compared to non-IBD patients. We conducted a prospective cohort study of registered IBD patients with confirmed COVID-19 from six provinces in Iran from February to April 2020. Proven COVID-19 patients were followed up at four weeks and the frequency of outcomes was assessed. Multivariable logistic regression was used to assess associations between demographics, clinical characteristics and COVID-19 outcomes. Overall, 2159 IBD patients and 4721 household members were enrolled, with 84 (3.9%) and 49 (1.1%) participants having confirmed COVID-19, respectively. Household spread of COVID-19 was not common in this cohort (1.2%). While hospitalization was significantly more frequent in IBD patients compared with non-IBD household members (27.1% vs. 6.0%, P=0.002), there was no significant difference in the frequency of severe cases. Age and presence of IBD were positively associated with hospitalization in IBD compared with non-IBD household members (OR: 1.06, 95% CI: 1.03-1.10; OR: 5.7, 95% CI: 2.02- 16.07, respectively). Age, presence of new gastrointestinal symptoms, and 5-aminosalicylic acid (5-ASA) use were associated with higher hospitalization rate in IBD patients (OR: 1.13, 95% CI: 1.05-1.23; OR: 6.49, 95% CI: 1.87-22.54; OR: 6.22, 95% CI: 1.90-20.36, respectively). Anti-tumor necrosis factor (TNF) was not associated with more severe outcomes. Age, presence of new gastrointestinal symptoms and use of 5-ASA were associated with increased hospitalization rate among IBD patients, while anti-TNF therapy had no statistical association.

Racial differences in the outcomes of IBD hospitalizations: a national population-based study.

There are scarce data describing the outcomes of hospitalized patients admitted with inflammatory bowel disease (IBD) stratified by race. In this retrospective cohort study, we evaluated the difference in outcomes between adult white and black patients hospitalized with a principal diagnosis of inflammatory bowel disease. Data were obtained from the 2016 and 2017 National Inpatient Sample (NIS) database. Our primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), total hospital charges (THC), red blood cell (RBC) transfusion, diagnosis of bowel perforation, and severe sepsis with septic shock. We conducted the analysis using STATA software. We used propensity-matched multivariate regression analysis to adjust for potential confounders. Among 71 million hospital hospitalizations, we found 177,574 hospitalizations with a principal diagnosis of IBD, with 24,635 (13.9%) for black patients, 124,899 (70.3%) for white patients, and 28,040 (15.8%) were for others. There was no significant difference in inpatient mortality for black vs white patients. Among secondary outcomes, white compared to black patients had increased odds of having a diagnosis of bowel perforation when admitted with a diagnosis of IBD while there was no difference in the odds of developing septic shock. White patients admitted with a diagnosis of UC were also found to have increased total LOS and THC. White patients hospitalized with a principal diagnosis of IBD had no difference in inpatient mortality or septic shock but had worse outcomes such as increased odds of bowel perforation compared to black patients.

S879 Race Stratified Trends in Hospitalizations for Inflammatory Bowel Disease Flare: A Retrospective Cohort Study

Introduction: Inflammatory bowel disease (IBD) describes a state of chronic, intermittent gastrointestinal inflammation, and remains a significant cause of inpatient morbidity. This study provides data on the nationwide trend of hospitalizations for IBD in the United States, after stratification by race. Given the significance that socioeconomic factors play on access to health care, we aim to examine the influence of household income on trends of hospitalizations for IBD in each of the major ethnic groups. Methods: The Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) was sourced for data involving adult hospitalizations for patients admitted with IBD (2005 to 2014). ICD-9 codes were used to query patients, and analysis of trend data was conducted using the Cochran-Mantel-Haenszel χ2 test of linear association. P values < 0.05 were considered statistically significant. The main outcome was percent change in number of admissions over the study period, stratified by race. Our secondary outcome analyzed race stratified trends in the percent of patients belonging to the four quartiles of family income. Analysis was done using SPSS software. Results: 232,910 adults were admitted from 2005 to 2014 with a primary diagnosis of IBD; UC (N= 81,232; 34.9%) CD (N= 151,678; 65.1%). Over the study period, White (CAU) patients with IBD were the single cohort with a decreasing trend in the number of admissions, and a decrease in percent change from 2005 to 2014 (%Δ = -7.55%). All other races had increasing trends in admissions and an increase in percent change of admissions. African American’s (AA: %Δ = +32.3%), Hispanic’s (HSP: % Δ = +29.3), Asians Native American, and others (%Δ = +27.8). Linear by linear association was significant (p ≤ 0.001) for all aforementioned trends (Figure 1, Table 1). By the study's end, AA patients had the greatest proportion of their cohort belonging to the poorest quartile of household income (Q1; AA: 47.2%, HSP: 35.70% CAU: 20.9%), and entered this quartile at the quickest rate (Figure 2). Conclusion: Healthcare disparity remains a complicated and costly burden. Research has shown the patients belonging to lower socioeconomic classes have limited access to healthcare, reduced health literacy, and environmental realities that contribute to increased morbidity and mortality. Our findings of increasing IBD-related hospitalizations and a greater percentage of minority patients in the poorest quartile highlight the impact of socioeconomic determinants.Figure 1.: (a, b): Display of the trend in IBD-related admissions stratified by race as proportions of the total number of IBD patients admitted (2005-2014). Linear by linear association was significant (p ≤ 0.001) for all aforementioned trends.Figure 2.: (a, b, c): Display of the yearly trend in patients belonging to one of the four quartiles of family income. (Q1) $1 - $45,999, (Q2) $46,000 - $58,999, (Q3) $59,000 - 78,999, (Q4) $79,000+Table 1.: Temporal trends in IBD-related admissions stratified by race proportions. Linear by linear association was significant (p ≤ 0.001) between groups.

Role of hospitalization for inflammatory bowel disease in the post-biologic era.

Treatment for inflammatory bowel disease (IBD) often requires specialized care. While much of IBD care has shifted to the outpatient setting, hospitalizations remain a major site of healthcare utilization and a sizable proportion of patients with inflammatory bowel disease require hospitalization or surgery during their lifetime. In this review, we approach IBD care from the population-level with a specific focus on hospitalization for IBD, including the shifts from inpatient to outpatient care, the balance of emergency and elective hospitalizations, regionalization of specialty IBD care, and contribution of surgery and endoscopy to hospitalized care.

Impact of atrial fibrillation on inflammatory bowel disease hospitalizations—a nationwide retrospective study

Systemic inflammation seen in inflammatory bowel disease (IBD) may cause electrophysiological changes in the atria leading to atrial fibrillation (AF). We analyzed data from the National Inpatient Sample for 2018 to identify all adult hospitalizations with a primary diagnosis of IBD, which were further divided based on the presence or absence of AF. The primary outcome was inpatient mortality while the secondary outcomes included inpatient complications, mean length of stay, and mean total hospital charge. We identified 92,055 IBD hospitalizations, of which 3900 (4.2%) had AF and 88,155 (95.8%) served as controls. IBD hospitalizations with AF were older (70.9 vs. 45.0 years, P < 0.001) and had a higher association with comorbidities compared to the non-AF cohort. Furthermore, the AF cohort had significantly higher adjusted odds of inpatient mortality (2.05% vs. 0.24%; adjusted odds ratio 2.07; 95% confidence interval [CI] 1.09–3.90; P = 0.025), longer length of stay (6.5 vs. 4.9 days; incidence rate ratio 1.23; 95% CI 1.14–1.33; P < 0.001), and higher total hospital charge ($14,587 vs. $11,475; incidence rate ratio 1.26; 95% CI 1.15–1.38; P < 0.001). Additionally, complications such as acute respiratory failure, pulmonary embolism, and necessity of blood product transfusion were more common for IBD hospitalizations with AF than those without.

The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study

BackgroundAnemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece.MethodsThis study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively.ResultsA total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%).ConclusionsThe frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to 4/5 of anemia IBD patients with the majority of them receiving iron intravenously.