Outcomes Of IBD Patients Research Articles

A220 A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RISK OF ADVERSE NEONATAL OUTCOME IN INFLAMMATORY BOWEL DISEASE AND PREGNANCY

Abstract Background Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes. Aims The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions. Methods Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed. Results Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35). Conclusions Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby. Funding Agencies None

DOP05 Perioperative Dietary Therapy in inflammatory bowel disease

Abstract Background The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. Methods A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn’s and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimisation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. Results A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. Conclusion Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn’s disease and ulcerative colitis. taking advantage of contemporary nutrition science.

P287 Patient sex does not affect endoscopic outcomes of biologicals in patients with inflammatory bowel disease, but is possibly associated with adverse events: A systematic review

Abstract Background There are several known factors influencing the efficacy and tolerability of biological therapies. Whether patient sex affects this is currently unclear, yet this knowledge would be helpful for risk and benefit stratification. This study assesses the role of patient sex on the efficacy and tolerability of biological therapies used for the treatment of IBD. Methods A systematic literature search was performed on 08 April 2019 using Embase (including Medline), Medline OvidSP, Cochrane Central Register of Controlled Trials, Web of Science and Pubmed. The primary outcome was the influence of patient sex on endoscopic outcomes in IBD patients treated with biologicals. The secondary outcome was the influence of patient sex on adverse events during biological therapy. Studies examining either of the outcomes were included in the assessment, regardless of study type or setting. Results The search yielded 19461 citations. After review 55 studies were included in the study, involving 28465 patients treated with adalimumab, certolizumab pegol, infliximab or vedolizumab. Of the 41 studies that objectively examined patient sex and efficacy of biological therapy, none found a significant association. Of the 14 studies examining patient sex and adverse events, 7 found that adverse events such as infections or skin lesions occur more frequently in female than in male patients. No meta-analysis of the primary or secondary outcome could be performed due to lack of exact reporting of summary measures. Conclusion There is no evidence for a sex difference in endoscopically measured response to biological therapies in IBD patients. However, there is a possible influence of sex on the occurrence of adverse events with a higher incidence in females.

Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry

Characteristics and Outcomes of IBD Patients with COVID-19 on Tofacitinib Therapy in the SECURE-IBD Registry

Association Between Inflammatory Bowel Disease and Colorectal Cancer Stage of Disease and Survival

BackgroundInflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). However, there are few data comparing outcomes between IBD and non–IBD-associated CRC. MethodsRetrospective cohort study of patients with CRC identified from the Veteran Affairs (VA) Central Cancer Registry from 1998 to 2012 linked to national VA administrative claims to identify patients with IBD using a previously validated algorithm. The association between IBD status and stage of disease and overall risk of death were evaluated using multivariable logistic and Cox regression, respectively. ResultsAmong 34,570 CRC patients, 217 had IBD. IBD patients were significantly younger for both colon and rectal cancer. IBD patients who developed rectal cancer were significantly more likely to present with locally advanced or metastatic disease (P = 0.007), but there was no difference in stage among patients with colon cancer. This difference persisted after multivariable adjustment (overall—odds ratio [OR] 1.40, 95% confidence interval [1.03-1.90]; colon—OR 1.22 [0.84-1.78]; rectum—OR 2.04 [1.22-3.40]). Total colectomy was more commonly performed among IBD patients. Overall, IBD was associated with a 52% increased risk of death (hazard ratio 1.52 [1.21-1.91]). ConclusionsAlthough IBD is associated with more advanced stage at diagnosis for rectal cancer, it is associated with a worse survival primarily in patients with colon cancer. Further work is needed to better understand the reason for these observed differences between IBD and non-IBD patients and to better delineate the impact of endoscopic surveillance on CRC care and outcomes in IBD patients.

Systematic review with meta-analysis: association of vitamin D status with clinical outcomes in adult patients with inflammatory bowel disease.

Vitamin D deficiency is highly prevalent among patients with IBD, however, data on its association with clinical outcomes are conflicting. To perform a systematic review and meta-analysis to explore the association of low vitamin D status with clinical outcomes in patients with IBD. We searched PubMed, Embase, Scopus and Web of Science from inception to February 2018 for observational studies evaluating the association of low 25(OH)D status on IBD disease activity, mucosal inflammation, clinical relapse and quality of life. Odds ratios (ORs) were pooled and analysed using a random effects model. Twenty-seven studies were eligible for inclusion comprising 8316 IBD patients (3115 ulcerative colitis, 5201 Crohn's disease). Among IBD patients, low 25(OH)D status was associated with increased odds of disease activity (OR 1.53, 95% CI 1.32-1.77, I2 =0%), mucosal inflammation (OR 1.25, 95% CI 1.06-1.47, I2 =0%), low quality of life (QOL) scores (OR 1.30, 95% CI 1.06-1.60, I2 =0%) and future clinical relapse (OR 1.23, 95% CI 1.03-1.47, I2 =0%). In subgroup analysis, low vitamin D status was associated with Crohn's disease activity (OR 1.66, 95% CI 1.36-2.03, I2 =0%), mucosal inflammation (OR 1.39, 95% CI 1.03-1.85, I2 =0%), clinical relapse (OR 1.35, 95% CI 1.14-1.59, I2 =0%), and low QOL scores (OR 1.25, 95% CI 1.04-1.50, I2 =0%) and ulcerative colitis disease activity (OR 1.47, 95% CI 1.03-2.09, I2 =0%) and clinical relapse (OR 1.20, 95% 1.01-1.43, I2 =0%). Low 25(OH)D status is a biomarker for disease activity and predictor of poor clinical outcomes in IBD patients.

Perioperative Dietary Therapy in Inflammatory Bowel Disease.

The incidence of inflammatory bowel disease [IBD] is rising worldwide and no cure is available. Many patients require surgery and they often present with nutritional deficiencies. Although randomised controlled trials of dietary therapy are lacking, expert IBD centres have long-established interdisciplinary care, including tailored nutritional therapy, to optimise clinical outcomes and resource utilisation. This topical review aims to share expertise and offers current practice recommendations to optimise outcomes of IBD patients who undergo surgery. A consensus expert panel consisting of dietitians, surgeons, and gastroenterologists, convened by the European Crohn's and Colitis Organisation, performed a systematic literature review. Nutritional evaluation and dietary needs, perioperative optimis ation, surgical complications, long-term needs, and special situations were critically appraised. Statements were developed using a Delphi methodology incorporating three successive rounds. Current practice positions were set when ≥80% of participants agreed on a recommendation. A total of 26 current practice positions were formulated which address the needs of IBD patients perioperatively and in the long term following surgery. Routine screening, perioperative optimisation by oral, enteral, or parenteral nutrition, dietary fibre, and supplements were reviewed. IBD-specific situations, including management of patients with a restorative proctocolectomy, an ostomy, strictures, or short-bowel syndrome, were addressed. Perioperative dietary therapy improves the outcomes of IBD patients who undergo a surgical procedure. This topical review shares interdisciplinary expertise and provides guidance to optimise the outcomes of patients with Crohn's disease and ulcerative colitis. taking advantage of contemporary nutrition science.

Systematic Review: Components of a Comprehensive Geriatric Assessment in Inflammatory Bowel Disease-A Potentially Promising but Often Neglected Risk Stratification.

BackgroundThe population of older patients with inflammatory bowel disease [IBD] is increasing. Patient age does not fully account for poor outcomes and its clinical utility for risk stratification is limited. Comprehensive geriatric assessment [CGA], comprising a somatic, functional, mental, and social assessment or frailty, could be a predictor tool.AimsTo systematically review literature on the kind of components of a CGA being used in adult IBD patients and the association of these components with adverse health outcomes.MethodsAn electronic literature search was performed on January 16, 2018, using PubMed, Embase, Web of Science, the Cochrane Library, CENTRAL, Emcare, and PsycINFO. Longitudinal studies relating somatic, functional, mental, and social assessment or frailty to adverse health outcomes during follow-up in IBD patients were included. The Newcastle-Ottawa scale was used to assess individual study quality.ResultsOf 4080 identified citations, 27 studies were included, reporting 169 associations. Median sample size was 108 patients (interquartile range [IQR] 60–704). No studies performed subgroup analyses on older patients, and the highest mean age reported was 52.7 years. Somatic and functional assessments were used in three studies, mental in 24, and social in five. No study assessed cognitive status, functional performance, or frailty. In 62 associations [36.7%], components of a CGA were significantly associated with adverse health outcome measurements.ConclusionsComponents of a CGA were associated with adverse health outcomes in IBD patients, but older patients were under-represented. More studies among older patients with IBD are warranted to further establish the clinical impact of a CGA.

DOP29 Pregnancy outcomes in IBD patients treated with vedolizumab, anti-TNF, or conventional therapy

Pregnancy outcomes in IBD patients treated with vedolizumab, anti-TNF, or conventional therapy

Managing Risks with Biologics

With a rapidly evolving complement of advanced targeted therapies in inflammatory bowel disease, additional safety and side effect concerns emerge. It is the purpose of this review to consider various risks with biologic therapies in inflammatory bowel disease and discuss mitigating strategies. Two recently approved monoclonal antibodies (vedolizumab and ustekinumab) and a Janus kinase inhibitor small molecule (tofacitnib) have introduced a number of novel safety and risk considerations. We review the clinical trial and real-world safety data to date on these agents as well as review new data and considerations with anti-tumor necrosis factor agents. New vaccines for varicella zoster virus, hepatitis B virus, and high-dose influenza have been studied, and we discuss the clinical importance of these findings. Lastly, we make management recommendations in the event of particular side effects or complications. Understanding the risks of new agents in inflammatory bowel disease, potential mitigating strategies, and management considerations is important to achieving and maintaining clinical outcomes in IBD patients.

The impact of sarcopenia and myosteatosis on postoperative outcomes in patients with inflammatory bowel disease

BackgroundInflammatory bowel disease (IBD) is a relatively common disorder with significant associated morbidity. Sarcopenia and myosteatosis are associated with adverse postoperative outcomes. This study investigated outcomes in IBD patients undergoing surgical resection relative to the presence of sarcopenia and myosteatosis.MethodsA retrospective analysis of a prospectively maintained surgical database was conducted. All patients undergoing elective or emergency resection for IBD between 2011 and 2016, with a contemporaneous perioperative computed tomography (CT) scan, were included. Patient demographics, clinical and biochemical measurements were collected. Skeletal muscle index and attenuation were measured on perioperative CT scans using Osirix version 5.6.1. Univariate and multivariate regression analysis was used to identify risk factors for adverse postoperative outcomes.ResultsSeventy-seven patients (46 male, 31 female; mean age 42 years, range 20–80 years) were included. Thirty patients (30%) had sarcopenia and 26 (34%) had myosteatosis. Myosteatosis was significantly associated with increased hospital stay postoperatively (9 versus 13 days). Sarcopenia and myosteatosis were associated with hospital readmission within 30 days on univariate analysis. Multivariate regression analysis demonstrated an independent association between myosteatosis and hospital readmission. Sixteen patients (21%) had a clinically relevant postoperative complication, but an association with sarcopenia and myosteatosis was not observed. A neutrophil-lymphocyte ratio greater than 5 was predictive of clinically relevant postoperative complications on multivariate regression analysis.ConclusionsMyosteatosis was associated with increased hospital stay and increased 30-day hospital readmission rates on multivariate regression analysis. Sarcopenia and myosteatosis in IBD were not associated with clinically relevant postoperative complications.

The impact of co-existing immune-mediated diseases on phenotype and outcomes in inflammatory bowel diseases.

Inflammatory bowel diseases lead to progressive bowel damage and need for surgery. While the increase in prevalence of other immune-mediated diseases in IBD is well recognised, the impact of this on the natural history of IBD is unknown. To determine the impact of concomitant immune-mediated diseases on phenotypes and outcomes in IBD. Patients with IBD enrolled in a prospective registry were queried about the presence of other immune-mediated diseases, defined as those where immune dysregulation plays a role in pathogenesis. Demographics and disease-related information were obtained. Subjects also completed measures of quality of life. Multivariable regression models compared disease phenotype and outcomes of IBD patients with and without other immune-mediated diseases. The cohort included 2145 IBD patients among whom 458 (21%) had another immune-mediated disease. There was no difference in CD phenotype between the two groups. UC patients were more likely to have pancolitis in the presence of another immune-mediated disease (62%) compared to those without (52%, P=0.02). IBD patients with another immune-mediated disease had higher rates of needing anti-TNF biologics [Odds ratio (OR) 1.31, 95% CI 1.05-1.63] and surgery (OR 1.26, 95% CI 0.99-1.61). The presence of another immune-mediated disease was also associated with lower disease-specific and general physical quality of life. The presence of another immune-mediated disease in IBD patients was associated with higher likelihood of pancolonic involvement in UC, and a modest increase in need for IBD-related surgery and anti-TNF biological therapy. Such patients also experienced worse quality of life.

Postoperative Venous Thromboembolism in Patients Undergoing Abdominal Surgery for IBD: A Common but Rarely Addressed Problem.

Venous thromboembolism after abdominal surgery occurs in 2% to 3% of patients with Crohn's disease and ulcerative colitis. However, no evidence-based guidelines currently exist to guide postdischarge prophylactic anticoagulation. We sought to determine the use of postoperative postdischarge venous thromboembolism chemical prophylaxis, 90-day venous thromboembolism rates, and factors associated with 90-day thromboembolic events in IBD patients following abdominal surgery. This was a retrospective evaluation of an administrative database. Data were obtained from Optum Labs Data Warehouse, a large administrative database containing claims on privately insured and Medicare Advantage enrollees. Seven thousand seventy-eight patients undergoing surgery for Crohn's disease or ulcerative colitis were included in the study. Primary outcomes were rates of postdischarge venous thromboembolism prophylaxis and 90-day rates of postdischarge thromboembolic events. In addition, patient clinical characteristics were identified to determine predictors of postdischarge venous thromboembolism. Postdischarge chemical prophylaxis was given to only 0.6% of patients in the study. Two hundred thirty-five patients (3.3%) developed a postdischarge thromboembolic complication. Postdischarge thromboembolism was more common in patients with ulcerative colitis than with Crohn's disease (5.8% vs 2.3%; p < 0.001). Increased rates of venous thromboembolism were seen in patients undergoing colectomy or proctectomy with simultaneous stoma creation compared with colectomy or proctectomy alone (5.8% vs 2.1%; p < 0.001). The strongest predictors of thromboembolic complications were stoma creation (adjusted OR, 1.95; 95% CI, 1.34-2.84), J-pouch reconstruction (adjusted OR, 2.66; 95% CI, 1.65-4.29), preoperative prednisone use (adjusted OR, 1.57; 95% CI, 1.19-2.08), and longer length of stay (adjusted OR, 1.89; 95% CI, 1.41-2.52). This study is limited by its retrospective design. The use of postdischarge venous thromboembolism prophylaxis in this patient sample was infrequent. Development of evidence-based guidelines, particularly for high-risk patients, should be considered to improve the outcomes of IBD patients undergoing abdominal surgery.

The Influence of Vedolizumab on Postoperative Outcomes in IBD Patients Undergoing Abdominal Surgery

The Influence of Vedolizumab on Postoperative Outcomes in IBD Patients Undergoing Abdominal Surgery

Obesity Does Not Impact Perioperative or Postoperative Outcomes in Patients with Inflammatory Bowel Disease

BackgroundWhile the prevalence of obesity in IBD patients is rapidly increasing, it is unclear if obesity impacts surgical outcomes in this population. We aim to investigate the effects of BMI on perioperative and postoperative outcomes in IBD patients by stratifying patients into BMI groups and comparing outcomes between these groups. MethodsThis is a retrospective cohort study where IBD patients who underwent intestinal surgeries between the years of 2000 to 2014 were identified. The patients were divided into groups based on BMI: underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obese (BMI ≥30). Preoperative patient demographics, operative variables, and postoperative complications were collected and compared between BMI groups. ResultsA total of 391 surgeries were reviewed (34 underweight, 187 normal weight, 105 overweight, and 65 obese) from 325 patients. No differences were observed in preoperative patient demographics, type of IBD, preoperative steroid or biologic mediator use, or mean laboratory values. No differences were observed in percent operative procedures with anastomosis, surgeries converted to open, estimated blood loss, intraoperative complications, and median operative time. Thirty-day postoperative complication rates including total complications, wound infection, or anastomotic leak were similar between groups. There was a statistically significant increased postoperative bleeding risk (p = 0.029) in underweight patients. The relative percent for increased postoperative bleeding risk between BMI groups was as follows: 2.9 % in underweight, zero in normal weight, 2.9 % in overweight, and zero in obese. ConclusionObesity does not appear to impact intraoperative variables nor does obesity appear to worsen postoperative complication rates in IBD patients.

Tu1524 Diagnostic Yield of Chromoendoscopy and Outcomes in IBD Patients With History of Dysplasia

Tu1524 Diagnostic Yield of Chromoendoscopy and Outcomes in IBD Patients With History of Dysplasia

Levels of anti-double-strand DNA but not antinuclear antibodies are associated with treatment efficacy and adverse outcomes in IBD patients treated with anti-TNF

Levels of anti-double-strand DNA but not antinuclear antibodies are associated with treatment efficacy and adverse outcomes in IBD patients treated with anti-TNF

Timing of Anti-TNF Therapy Influences Short-Term Outcomes in IBD Patients

The optimal time to initiate anti-TNF therapy in patients with IBD is uncertain. There is emerging evidence that early use of these agents in patients with moderate-to-severe disease may alter the natural history of IBD. We set out determine whether the earlier use of anti-TNF therapy was associated with better short-term outcomes in a biologic-naïve cohort. A retrospective cohort of patients with biopsy-proven UC or CD, naïve to biologic therapy, who started therapy with infliximab (IFX), adalimumab (ADA) or certolizumab (CTZ) between 2000-2011, was selected. Subjects with a prior history of IBD-related surgery were excluded. Primary non-responders to biologic therapy, individuals who were on corticosteroids beyond the biologic induction period, and subjects with less than six months of continuous follow-up were also excluded. Subjects were followed for a maximum of three years or until lost to follow up. The primary outcome of interest was the occurrence of any IBD-related hospitalization, surgery or corticosteroid use (after biologic induction) during follow-up. Subjects were stratified according to whether they started a biologic early (within 1 year of IBD diagnosis) or late (>1 year since diagnosis). Multivariable logistic regression was performed with the composite outcome as the dependent variable of interest. A survival analysis was also performed comparing early versus late initiators and their time to the composite outcome with subjects censored at three years or when lost to follow up. Early initiators (N = 34) were younger (mean age Δ 5.4 years) than late initiators (N = 78) (P = 0.02), and had a higher frequency of ADA/CTZ use than the late initiators (38.2% versus 15.4%, P = 0.03). They were also more likely to be on corticosteroids at the time of biologic initiation (64.7% versus 42.3%, P = 0.03) and less likely to be on aminosalicylates (8.8% versus 28.2%, P = 0.02). The groups did not differ by sex distribution, mean body weight, immunomodulator use, presence of extra-intestinal disease, tobacco use or IBD subtype (including clinical phenotype among CD patients or extent of colitis among UC patients) (P>0.10). The mean follow-up time between groups did not differ (719 days [SE 57.9] in the early group versus 774 days [SE 41.1] in the late group, P = 0.45). After multivariable adjustment, there was a higher likelihood of the composite outcome in late initiators of biologic therapy (adjusted OR 6.6, SE 5.5, P = 0.02). When initiation was considered as a continuous function, it remained significantly associated with the composite outcome (adjusted OR 1.1 per year since diagnosis, SE 0.06, P = 0.05). When modeled as a survival function, the adjusted hazard ratio for the composite outcome was 4.9 in the late initiators (SE 3.8, P = 0.04). Early initiation of anti-TNF therapy in patients with IBD who already have indications for its use may be associated with better outcomes. These findings support a possible role for “top-down” therapy in IBD treatment. This is in line with other emerging data that the early use of anti-TNF agents may alter the natural history of IBD.

Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease

The increasing incidence of Clostridium difficile (C. difficile) infection (CDI) among patients with inflammatory bowel disease is well recognised. However, most studies have focused on demonstrating that CDI is associated with adverse outcomes in IBD patients. Few have attempted to identify predictors of severe outcomes associated with CDI among IBD patients. To identify clinical and laboratory factors that predict severe outcomes associated with CDI in IBD patients. From a multi-institution EMR database, we identified all hospitalised patients with at least one diagnosis code for C. difficile from among those with a diagnosis of Crohn's disease or ulcerative colitis. Our primary outcome was time to total colectomy or death with follow-up censored at 180 days after CDI. Cox proportional hazards models were used to identify predictors of the primary outcome from among demographic, disease-related, laboratory and medication variables. A total of 294 patients with CDI-IBD were included in our study. Of these, 58 patients (20%) met our primary outcome (45 deaths, 13 colectomy) at a median of 31 days. On multivariate analysis, serum albumin <3 g/dL (HR 5.75, 95% CI 1.34-24.56), haemoglobin below 9 g/dL (HR 5.29, 95% CI 1.58-17.69) and creatinine above 1.5 mg/dL (HR 1.98, 95% CI 1.04-3.79) were independent predictors of our primary outcome. Examining laboratory parameters as continuous variables or shortening our primary outcome to include events within 90 days yielded similar results. Serum albumin below 3 g/dL, haemoglobin below 9 g/dL and serum creatinine above 1.5 mg/dL were independent predictors of severe outcomes in hospitalised IBD patients with Clostridium difficile infection.