Akhuemonkhan Eboselume, Parian Alyssa, Miller Kay, Hanauer Stephen, Hutfless Susan
Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, USA.
Truven Health Analytics, an IBM Company.
BMJ Open Gastroenterol. 2017 Jul 3;4(1):e000155. doi: 10.1136/bmjgast-2017-000155. eCollection 2017.
Anaemia affects up to 74% patients with Crohn's disease (CD) and ulcerative colitis (UC) and is correlated with decreased quality of life. The European Crohn's and Colitis Organisation (ECCO) recommends at least annual screening for iron-deficiency anaemia. We aimed to determine the prevalence of anaemia, frequency of anaemia screening and factors associated with anaemia in a retrospective study of mild to moderate inflammatory bowel disease (IBD) in the USA.
Adults with at least two outpatient encounters for IBD between 2010 through 2014 who contributed laboratory information were identified from MarketScan, a US commercial claims database. Hospitalised patients were considered severe and excluded from the study. WHO criteria defined anaemia. Iron-deficiency anaemia was evaluated using ferritin and C reactive protein.
The eligible population included 17 059 adults, 43.9% with CD. During the 2-year median follow-up period, 68.1% of patients with CD and 65.3% of patients with UC were screened for anaemia. The prevalence of anaemia among those screened was 32.4% in CD and 27.6% in UC. Among 669 persons with sufficient information, 79.2% of those with CD and 85.1% of those with UC had iron-deficiency anaemia. Factors associated with anaemia were similar for those with CD and UC and included ≥6 IBD-related outpatient visits, female sex, age and smoking.
More than 30% of patients with IBD in the USA were not screened for anaemia during a 2-year period. Approximately 82% of anaemic patients were iron deficient, although the absence of ferritin results limited the findings. Incorporation of screening for anaemia and, in particular, iron deficiency, should be a component of international treatment guidelines.
贫血影响高达74%的克罗恩病（CD）和溃疡性结肠炎（UC）患者，且与生活质量下降相关。欧洲克罗恩病和结肠炎组织（ECCO）建议至少每年筛查缺铁性贫血。我们旨在通过一项对美国轻至中度炎症性肠病（IBD）的回顾性研究，确定贫血的患病率、贫血筛查频率以及与贫血相关的因素。
从美国商业索赔数据库MarketScan中识别出2010年至2014年间至少有两次IBD门诊就诊且提供了实验室信息的成年人。住院患者被视为重症患者并排除在研究之外。采用世界卫生组织标准定义贫血。使用铁蛋白和C反应蛋白评估缺铁性贫血。
符合条件的人群包括17059名成年人，其中43.9%患有CD。在为期2年的中位随访期内，68.1%的CD患者和65.3%的UC患者接受了贫血筛查。筛查人群中，CD患者的贫血患病率为32.4%，UC患者为27.6%。在669名有足够信息的患者中，79.2%的CD患者和85.1%的UC患者患有缺铁性贫血。CD患者和UC患者中与贫血相关的因素相似，包括≥6次与IBD相关的门诊就诊、女性、年龄和吸烟。
在美国，超过30%的IBD患者在2年内未接受贫血筛查。约82%的贫血患者缺铁，尽管铁蛋白结果缺失限制了研究结果。将贫血筛查，尤其是缺铁筛查纳入国际治疗指南应成为其中一部分。
