Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.
Am J Gastroenterol. 2013 Feb;108(2):240-8. doi: 10.1038/ajg.2012.406. Epub 2013 Jan 8.
Patients with inflammatory bowel disease (IBD) may be at increased risk for infections. We aimed to determine the pneumonia risk in IBD and how specific medications affect this risk.
We performed a retrospective cohort and a nested case-control study using administrative data from IMS Health Inc., LifeLink Health Plan Claims Database. Limitations to this data set include lack of clinical details to validate exposures and outcomes. In the cohort, IBD patients were matched to four individuals without IBD. Pneumonia risk was evaluated by incidence rate ratio (IRR) and adjusted Cox proportional hazards models (hazard ratio (HR)). In the nested case-control, 4,856 IBD patients with pneumonia were matched to four IBD patients without pneumonia by incidence density sampling. We used conditional logistic regression to determine the associations between medications and pneumonia.
The cohort included 50,932 patients with Crohn's disease (CD), 56,403 patients with ulcerative colitis (UC), and 1,269 with unspecified IBD; matched to 434,416 individuals without IBD. Median follow-up within the cohort was 24 months. The IBD cohort had an increased pneumonia risk when compared with non-IBD (IRR 1.82, 95% confidence interval (CI) 1.75-1.88). In adjusted Cox analysis, pneumonia risk remained increased for the IBD vs. non-IBD cohort (HR 1.54, 95% CI 1.49-1.60), with increased risk in both CD (HR 1.71, 95% CI 1.62-1.80) and UC (HR 1.41, 95% CI 1.34-1.48). In the nested case-control analysis, use of biologic medications (odds ratio (OR) 1.32, 95% CI 1.11-1.57), corticosteroids (OR 1.91, 95% CI 1.72-2.12), thiopurines (OR 1.13, 95% CI 1.00-1.27), proton-pump inhibitors (PPIs) (OR 1.15, 95% CI 1.04-1.26), or narcotics (2.28, 95% CI 2.09-2.48) was independently associated with pneumonia.
Patients with IBD are at increased risk for pneumonia. Medications such as corticosteroids and narcotics are particularly associated with pneumonia in this population. An emphasis upon primary prevention of pneumonia through vaccination and reduction of risk factors is warranted.
患有炎症性肠病（IBD）的患者可能面临更高的感染风险。我们旨在确定 IBD 患者的肺炎风险，以及特定药物如何影响这种风险。
我们使用 IMS Health Inc.，LifeLink Health Plan Claims Database 的行政数据进行了回顾性队列研究和嵌套病例对照研究。该数据集的局限性包括缺乏临床细节来验证暴露和结果。在队列中，将 IBD 患者与四名没有 IBD 的个体相匹配。肺炎风险通过发病率比率（IRR）和调整后的 Cox 比例风险模型（风险比（HR））进行评估。在嵌套病例对照中，通过发病率密度抽样将 4856 名患有肺炎的 IBD 患者与 4 名没有肺炎的 IBD 患者相匹配。我们使用条件逻辑回归来确定药物与肺炎之间的关联。
队列包括 50932 名克罗恩病（CD）患者、56403 名溃疡性结肠炎（UC）患者和 1269 名未明确 IBD 患者；与 434416 名没有 IBD 的个体相匹配。队列内的中位随访时间为 24 个月。与非 IBD 患者相比，IBD 队列的肺炎风险增加（IRR 1.82，95%置信区间（CI）1.75-1.88）。在调整后的 Cox 分析中，IBD 与非 IBD 队列相比，肺炎风险仍然增加（HR 1.54，95%CI 1.49-1.60），CD（HR 1.71，95%CI 1.62-1.80）和 UC（HR 1.41，95%CI 1.34-1.48）均有较高风险。在嵌套病例对照分析中，使用生物药物（比值比（OR）1.32，95%CI 1.11-1.57）、皮质类固醇（OR 1.91，95%CI 1.72-2.12）、硫嘌呤（OR 1.13，95%CI 1.00-1.27）、质子泵抑制剂（PPIs）（OR 1.15，95%CI 1.04-1.26）或麻醉剂（2.28，95%CI 2.09-2.48）与肺炎独立相关。
患有 IBD 的患者患肺炎的风险增加。皮质类固醇和麻醉剂等药物在该人群中与肺炎特别相关。通过疫苗接种和减少危险因素来强调肺炎的一级预防是必要的。
