Mortality in older IBD inpatients

December 1, 2020

Issue 02

Clinical Question

What impact does age have on mortality in inpatients admitted for IBD-related reasons?

Editor’s Bottom Line

Older patients who are hospitalized for IBD face higher mortality rates, often due to infection. Clinicians should incorporate this risk in strategies for treatment and monitoring.

Reference

Schwartz J, Stein DJ, Lipcsey M, et al. High Rates of Mortality in Geriatric Patients Admitted for Inflammatory Bowel Disease Management. J Clin Gastroenterol. 2022;56(1):e20–26; https://journals.lww.com/jcge/Abstract/2022/01000/.aspx

Synopsis

This analysis included data from 162,800 Crohn’s disease (CD)-related hospital admissions and 96,450 admissions for reasons related to ulcerative colitis (UC) in 2016 and 2017 in the United States. The information was gathered from the National Inpatient Sample (NIS).

Twenty percent and 30% of CD and UC-related admissions were in patients 65 years or older, with roughly 32% of older patients admitted for infectious complications of IBD. The remaining older IBD patients were hospitalized for obstruction, bleeding or anemia related to IBD. In the inpatient setting, older patients had higher rates of Clostridium difficile infections, lower rates of surgery and lower rates of bleeding related to UC, and fistulae or abscesses related to CD.

Among CD patients, 3.9% of older individuals and 0.5% of those below 65 years of age died during hospitalization (p<0.001), while 5% of older and 1% of younger UC patients died during hospitalization (p<0.001).

Analyses adjusting for a range of variables, including the number of comorbidities, showed that older age was independently associated with a higher risk of death in both CD patients [Odds Ratio (OR): 3.47; 95% Confidence Interval (CI), 2.72–4.44] and UC patients (OR: 2.75; 95% CI, 2.16–3.49). In roughly 80% of all older IBD patients, the cause of death was infection related.

Other outcomes that differed by age after adjusting for possible confounding variables included length of hospital stay and cost of care in older patients with CD. There were no significant age-related differences in older patients with UC after adjusting for possible confounding variables.

Details

Study Design: Retrospective database analysis

Funding: None

Allocation: Not applicable

Setting: Single center

Level of Evidence: 2b