Excess burden of critical illness related to inflammatory bowel disease.
incidence
inflammatory bowel disease
intensive care unit
mortality
population based
risk factor
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
13
12
2021
received:
31
08
2021
accepted:
13
12
2021
medline:
25
5
2023
pubmed:
22
12
2021
entrez:
21
12
2021
Statut:
ppublish
Résumé
Although inflammatory bowel disease (IBD) is associated with major morbidity and mortality, few studies have evaluated its associated burden of critical illness. To examine the epidemiology and outcome of intensive care unit (ICU) admission among patients with IBD in North Brisbane, Australia. A population-based cohort design was used. All admissions to ICU serving the Metro North Hospital and Health Service among adult residents during 2017-2019 were included. Data were obtained from ICU clinical information systems with linkages to statewide admissions and death registries. Among 9011 ICU admissions, 101 (1.1%) were among patients with IBD, of which 57 (0.6%) and 44 (0.5%) had ulcerative colitis (UC) and Crohn disease (CD) respectively. The incidence of ICU admission was 379, 1336, 1514 and 1429 per 100 000 annually among those without IBD, CD, UC and IBD respectively. Patients with IBD were at excess risk for admission across all age groups, with women aged <50 years at highest risk and men thereafter. The all-cause 90-day case-fatality rates following ICU admission were not significantly different among patient groups and were 18%, 12%, 15% and 12% for CD, UC, IBD and non-IBD respectively. However, as compared with non-IBD patients, those with CD (151.8 vs 39.4 per 100 000; relative risk (RR) 3.85; 95% confidence interval (CI) 1.25-9.02; P = 0.013), UC (159.4 vs 39.4 per 100 000; RR 4.05; 95% CI 1.48-8.84; P = 0.005) and IBD (155.6 vs 39.4 per 100 000; RR 3.95; 95% CI 1.96-7.10; P = 0.002) were at significantly higher risk for mortality. Patients with IBD suffer a major burden of critical illness.
Sections du résumé
BACKGROUND
Although inflammatory bowel disease (IBD) is associated with major morbidity and mortality, few studies have evaluated its associated burden of critical illness.
AIMS
To examine the epidemiology and outcome of intensive care unit (ICU) admission among patients with IBD in North Brisbane, Australia.
METHODS
A population-based cohort design was used. All admissions to ICU serving the Metro North Hospital and Health Service among adult residents during 2017-2019 were included. Data were obtained from ICU clinical information systems with linkages to statewide admissions and death registries.
RESULTS
Among 9011 ICU admissions, 101 (1.1%) were among patients with IBD, of which 57 (0.6%) and 44 (0.5%) had ulcerative colitis (UC) and Crohn disease (CD) respectively. The incidence of ICU admission was 379, 1336, 1514 and 1429 per 100 000 annually among those without IBD, CD, UC and IBD respectively. Patients with IBD were at excess risk for admission across all age groups, with women aged <50 years at highest risk and men thereafter. The all-cause 90-day case-fatality rates following ICU admission were not significantly different among patient groups and were 18%, 12%, 15% and 12% for CD, UC, IBD and non-IBD respectively. However, as compared with non-IBD patients, those with CD (151.8 vs 39.4 per 100 000; relative risk (RR) 3.85; 95% confidence interval (CI) 1.25-9.02; P = 0.013), UC (159.4 vs 39.4 per 100 000; RR 4.05; 95% CI 1.48-8.84; P = 0.005) and IBD (155.6 vs 39.4 per 100 000; RR 3.95; 95% CI 1.96-7.10; P = 0.002) were at significantly higher risk for mortality.
CONCLUSIONS
Patients with IBD suffer a major burden of critical illness.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
812-818Informations de copyright
© 2021 Royal Australasian College of Physicians.
Références
GBD 2017 Inflammatory Bowel Disease Collaborators. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5: 17-30.
Dong C, Metzger M, Holsbø E, Perduca V, Carbonnel F. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther 2020; 51: 8-33.
Ribaldone DG, Vernero M, Parisi S, Ditto MC, Pellicano R, Morino M et al. Risk factors of suspected spondyloarthritis among inflammatory bowel disease patients. Scand J Gastroenterol 2019; 54: 1233-6.
Hiller A, Biedermann L, Fournier N, Butter M, Vavricka SR, Ciurea A et al. The appearance of joint manifestations in the Swiss inflammatory bowel disease cohort. PLoS One 2019; 14: e0211554.
States V, O'Brien S, Rai JP, Roberts HL, Paas M, Feagins K et al. Pyoderma gangrenosum in inflammatory bowel disease: a systematic review and meta-analysis. Dig Dis Sci 2020; 65: 2675-85.
Law CC, Bell C, Koh D, Bao Y, Jairath V, Narula N. Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease. Cochrane Database Syst Rev 2020; CD013256.
Kuenzig ME, Manuel DG, Donelle J, Benchimol EI. Life expectancy and health-adjusted life expectancy in people with inflammatory bowel disease. CMAJ 2020; 192: e1394-402.
Chupin A, Perduca V, Meyer A, Bellanger C, Carbonnel F, Dong C. Systematic review with meta-analysis: comparative risk of lymphoma with anti-tumour necrosis factor agents and/or thiopurines in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 52: 1289-97.
Ha C, Maser EA, Kornbluth A. Clinical presentation and outcomes of inflammatory bowel disease patients admitted to the intensive care unit. J Clin Gastroenterol 2013; 47: 485-90.
Huber W, Herrmann G, Schuster T, Phillip V, Saugel B, Schultheiss C et al. [Life-threatening complications of Crohn's disease and ulcerative colitis: a systematic analysis of admissions to an ICU during 18 years]. Dtsch Med Wochenschr 2010; 135: 668-74.
Malhotra A, Mandip KC, Shaukat A, Rector T. All-cause hospitalizations for inflammatory bowel diseases: can the reason for admission provide information on inpatient resource use? A study from a large veteran affairs hospital. Mil Med Res 2016; 3: 28.
Marrie RA, Garland A, Peschken CA, Hitchon CA, Chen H, Fransoo R et al. Increased incidence of critical illness among patients with inflammatory bowel disease: a population-based study. Clin Gastroenterol Hepatol 2014; 12: 2063-70.e2061-2064.
Bernstein CN, Garland A, Peschken CA, Hitchon CA, Chen H, Fransoo R et al. Predictors of ICU admission and outcomes 1 year post-admission in persons with IBD: a population-based study. Inflamm Bowel Dis 2015; 21: 1341-7.
Laupland KB. Defining the epidemiology of bloodstream infections: the 'gold standard' of population-based assessment. Epidemiol Infect 2013; 141: 2149-57.
Metro North Health Queensland Health. [cited 2020 Nov 23]. Available from URL: https://metronorth.health.qld.gov.au/hospitals-services
ANZICS Core outcome measurement and evaluation tool. [cited 2020 Nov 24]. Available from URL: https://www.anzics.com.au/comet-core-outcome-measurement-and-evaluation-tool/
ANZICS Centre for Outcome and Resource Evaluation Adult Patient Database. [cited 2019 Sep 18]. Available from URL: https://www.anzics.com.au/adult-patient-database-apd/
Queensland Health Death registration and coded cause of death data. [cited 2019 Sep 23]. Available from URL: https://www.health.qld.gov.au/data/assets/pdf_file/0032/644828/commonly_requested_data_items-deaths.pdf
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004; 57: 1288-94.
Tableau Public Queensland population projections 2002 to 2026. Queensland Government. [cited 2019 Feb 19]. Available from URL: https://public.tableau.com/profile/tim.roselli#!/vizhome/HHSpopulationprojections/Display
Crohn's & Colitis Australia The economic costs of Crohn's disease and ulcerative colitis. [cited 2021 Mar 1]. Available from URL: https://www.crohnsandcolitis.com.au/site/wp-content/uploads/Deloitte-Access-Economics-Report.pdf
Okamoto VN, Rubenfeld GD. Attending to the lightness of numbers: toward the understanding of critical care epidemiology. Crit Care 2004; 8: 422-4.
Steckelberg JM, Melton LJ 3rd, Ilstrup DM, Rouse MS, Wilson WR. Influence of referral bias on the apparent clinical spectrum of infective endocarditis. Am J Med 1990; 88: 582-8.
Laupland KB, Tabah A, Holley AD, Bellapart J, Pilcher DV. Decreasing case-fatality but not mortality rate following admission to intensive care units in Australia, 2005-2018. Chest 2020; 159: 1503-6.
Studd C, Cameron G, Beswick L, Knight R, Hair C, McNeil J et al. Never underestimate inflammatory bowel disease: high prevalence rates and confirmation of high incidence rates in Australia. J Gastroenterol Hepatol 2016; 31: 81-6.
Bhatia R, Yeoh SW, Vaz K, Studd C, Wilson J, Bell S et al. Inflammatory bowel disease incidence, prevalence and 12-month initial disease course in Tasmania, Australia. Intern Med J 2019; 49: 622-30.