*Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; †Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin; ‡Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; and §Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Inflamm Bowel Dis. 2017 Oct;23(10):1847-1852. doi: 10.1097/MIB.0000000000001218.
Risk of venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD) is well established; however, there is paucity of data on the potential added risk of VTE in patients with IBD with Clostridium difficile infection (CDI). We sought to study the difference in VTE rates in hospitalized patients with IBD with CDI compared to those without CDI.
We queried Nationwide Inpatient Sample from year 2011 to identify patients ≥18 years of age with a discharge diagnosis of IBD (i.e., Crohn's disease and ulcerative colitis) based on ICD-9-CM codes 555.xx and 556.xx, respectively. Patients were further divided into 2 groups: those with and without CDI. To adjust and control for potential baseline differences between groups, 1:1 propensity matching was performed. Multivariate regression analysis was used to evaluate the difference in VTE rates in 2 groups.
Of 312,147 patients with the discharge diagnosis of IBD, 12,560 (4%) had CDI. VTE was present 6% in group with CDI versus 3% in group without CDI (P < 0.001). On performing multivariate analysis after propensity-score matching, CDI was significantly associated with VTE (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.2, P < 0.001). On subgroup analysis, Crohn's disease with CDI had a higher association with VTE compared with Crohn's disease only. Similarly, ulcerative colitis with CDI had a higher association with VTE compared with ulcerative colitis only.
Rate of VTE was higher in hospitalized patients with IBD with CDI compared with those without CDI, necessitating extra vigilance in this patient population.
患有炎症性肠病（IBD）的患者发生静脉血栓栓塞症（VTE）的风险已得到充分证实；然而，关于患有艰难梭菌感染（CDI）的 IBD 患者发生 VTE 的潜在风险增加的数据却很少。我们旨在研究与没有 CDI 的患者相比，患有 CDI 的 IBD 住院患者的 VTE 发生率差异。
我们从 2011 年的全国住院患者样本中查询了年龄≥18 岁的患者，其出院诊断为 IBD（即，基于 ICD-9-CM 代码 555.xx 和 556.xx 的分别为克罗恩病和溃疡性结肠炎）。患者进一步分为 2 组：有 CDI 和没有 CDI。为了调整和控制组间潜在的基线差异，进行了 1：1 倾向评分匹配。采用多变量回归分析评估 2 组之间 VTE 发生率的差异。
在 312147 例具有 IBD 出院诊断的患者中，有 12560 例（4%）患有 CDI。CDI 组的 VTE 发生率为 6%，而无 CDI 组的 VTE 发生率为 3%（P<0.001）。在进行倾向评分匹配后的多变量分析中，CDI 与 VTE 显著相关（校正优势比 1.7，95%置信区间 1.4-2.2，P<0.001）。在亚组分析中，与仅患有克罗恩病的患者相比，患有 CDI 的克罗恩病患者与 VTE 的相关性更高。同样，与仅患有溃疡性结肠炎的患者相比，患有 CDI 的溃疡性结肠炎患者与 VTE 的相关性更高。
与没有 CDI 的患者相比，患有 CDI 的 IBD 住院患者的 VTE 发生率更高，这需要对该患者群体保持额外的警惕。
