Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Department of Internal Medicine, Rochester General Hospital, Rochester, NY.
J Clin Gastroenterol. 2019 Feb;53(2):127-133. doi: 10.1097/MCG.0000000000000968.
Clostridium difficile infection (CDI) has been associated with an increased mortality risk among patients with inflammatory bowel disease (IBD) in multiple observational studies. We performed a systematic review and meta-analysis to help clearly define the magnitude of risk in IBD patients with and without CDI, and to assess the risk in individual IBD subtypes.
A systematic search of multiple electronic databases was conducted for observational studies reporting the risk of mortality in IBD, stratified by the presence of CDI. Weighted summary estimates were calculated using generalized inverse variance with random-effects model. Study quality was assessed using the Newcastle-Ottawa scale.
Ten observational studies were identified (8 from North America and 2 from Europe) and included 40,700 IBD patients with CDI and 1,320,764 IBD controls without CDI. Overall, IBD patients with CDI had a higher risk of mortality compared with IBD patients without CDI [odds ratios (OR), 4.39; 95% confidence interval (CI), 3.56-5.42; I=93%]. The results were stable in high-quality studies and in hospitalized patients. When patients were stratified by IBD type, CDI was associated with increased mortality in patients with ulcerative colitis (7 studies) (OR, 4.39; 95% CI, 3.44-5.61; I), but not in patients with Crohn's disease (4 studies) (OR, 2.21; 95% CI, 0.84-5.77; I). Individual studies were limited by an inability to control for IBD disease activity and therapeutic interventions.
On the basis of 10 observational studies with at least moderate quality, CDI seems to increase mortality risk in IBD, particularly in ulcerative colitis. These findings are a cause for concern and suggest that CDI should be managed aggressively in patients with IBD.
在多项观察性研究中，艰难梭菌感染（CDI）与炎症性肠病（IBD）患者的死亡率增加相关。我们进行了系统评价和荟萃分析，以帮助明确 IBD 患者中 CDI 患者和非 CDI 患者的风险幅度，并评估各 IBD 亚型的风险。
对报告 IBD 患者死亡率的观察性研究进行了系统检索，按 CDI 的存在进行分层。使用具有随机效应模型的广义倒数方差法计算加权汇总估计值。使用纽卡斯尔-渥太华量表评估研究质量。
确定了 10 项观察性研究（8 项来自北美，2 项来自欧洲），包括 40700 例 CDI 的 IBD 患者和 1320764 例无 CDI 的 IBD 对照。总体而言，与无 CDI 的 IBD 患者相比，CDI 的 IBD 患者死亡率更高[比值比（OR），4.39；95%置信区间（CI），3.56-5.42；I=93%]。高质量研究和住院患者的结果稳定。当按 IBD 类型对患者进行分层时，CDI 与溃疡性结肠炎（7 项研究）患者的死亡率增加相关（OR，4.39；95%CI，3.44-5.61；I），但与克罗恩病（4 项研究）患者无关（OR，2.21；95%CI，0.84-5.77；I）。个别研究受到无法控制 IBD 疾病活动和治疗干预的限制。
基于至少具有中等质量的 10 项观察性研究，CDI 似乎会增加 IBD 的死亡率风险，尤其是在溃疡性结肠炎中。这些发现令人担忧，表明 CDI 应在 IBD 患者中积极治疗。
