Voth Elida, Solanky Dipesh, Loftus Edward V, Pardi Darrell S, Khanna Sahil
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Therap Adv Gastroenterol. 2021 Mar 12;14:1756284821997792. doi: 10.1177/1756284821997792. eCollection 2021.
Patients with inflammatory bowel disease (IBD) are at significantly increased risk for infection (CDI) with an increased risk of adverse outcomes including increased in-hospital mortality, IBD treatment failure, re-hospitalization, and high CDI recurrence rates. The existing literature on predictors of these adverse outcomes is limited. We evaluated four potentially modifiable novel risk factors [body mass index (BMI), statin use, opioid use, and antidepressant use] on CDI risk and adverse outcomes in these patients.
Using a retrospective design, variables were abstracted from records for patients with IBD and CDI from 2008 to 2013. Statistical analysis comprised descriptive statistics and univariate and multivariate logistic regression analyses.
There were 137 patients with IBD and CDI included in this study. On multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe, complicated CDI, compared with 22% of patients in the underweight/normal BMI [odds ratio (OR) 2.85, = 0.02] and 19% in the obese category (OR 3.95, = 0.04). Statin use was associated with severe or severe, complicated CDI when controlling for age and BMI (OR 5.66, = 0.01). There was no association between statin use and IBD exacerbations following CDI. Opioid and antidepressant use were not associated with disease severity or frequency of IBD exacerbations following CDI.
An overweight BMI and statin use were associated with severe or severe, complicated CDI in IBD patients. Further studies are needed to better understand how these factors impact management of patients with IBD to improve clinical outcomes and potentially reduce the risk of complications from CDI.
炎症性肠病（IBD）患者发生艰难梭菌感染（CDI）的风险显著增加，不良结局风险也随之升高，包括住院死亡率增加、IBD治疗失败、再次住院以及CDI复发率高。关于这些不良结局预测因素的现有文献有限。我们评估了四个潜在可改变的新风险因素[体重指数（BMI）、他汀类药物使用、阿片类药物使用和抗抑郁药使用]对这些患者CDI风险和不良结局的影响。
采用回顾性设计，从2008年至2013年IBD和CDI患者的记录中提取变量。统计分析包括描述性统计以及单变量和多变量逻辑回归分析。
本研究纳入了137例IBD和CDI患者。在对年龄进行多变量分析时，超重BMI类别的患者中有43%发生了严重或重度、复杂性CDI，而体重过轻/正常BMI类别的患者中这一比例为22%[比值比（OR）2.85，P = 0.02]，肥胖类别的患者中为19%（OR 3.95，P = 0.04）。在控制年龄和BMI后，他汀类药物的使用与严重或重度、复杂性CDI相关（OR 5.66，P = 0.01）。他汀类药物使用与CDI后IBD病情加重之间无关联。阿片类药物和抗抑郁药的使用与CDI后IBD病情严重程度或病情加重频率无关。
超重BMI和他汀类药物的使用与IBD患者严重或重度、复杂性CDI相关。需要进一步研究以更好地了解这些因素如何影响IBD患者的管理，从而改善临床结局并可能降低CDI并发症的风险。
