因炎症性肠病发作并发艰难梭菌感染而住院的老年患者出院后的结局

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection.

作者信息

Goren Idan, Fallek Boldes Ortal, Boldes Tomer, Knyazev Oleg, Kagramanova Anna, Limdi Jimmy K, Liu Eleanor, Sethi-Arora Karishma, Holvoet Tom, Eder Piotr, Bezzio Cristina, Saibeni Simone, Vernero Marta, Alimenti Eleonora, Chaparro María, Gisbert Javier P, Orfanoudaki Eleni, Koutroubakis Ioannis E, Pugliese Daniela, Cuccia Giuseppe, Calviño Suarez Cristina, Ribaldone Davide Giuseppe, Veisman Ido, Sharif Kassem, Festa Stefano, Aratari Annalisa, Papi Claudio, Mylonas Iordanis, Mantzaris Gerassimos J, Truyens Marie, Lobaton Ortega Triana, Nancey Stéphane, Castiglione Fabiana, Nardone Olga Maria, Calabrese Giulio, Karmiris Konstantinos, Velegraki Magdalini, Theodoropoulou Angeliki, Shitrit Ariella Bar-Gil, Lukas Milan, Vojtechová Gabriela, Ellul Pierre, Bugeja Luke, Savarino Edoardo V, Fischler Tali Sharar, Dotan Iris, Yanai Henit

机构信息

Division of Gastroenterology, Rabin Medical Center, Affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.

Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY, USA.

出版信息

J Crohns Colitis. 2025 May 8;19(5). doi: 10.1093/ecco-jcc/jjae161.

DOI:10.1093/ecco-jcc/jjae161

PMID:39435855

Abstract

OBJECTIVES

Elderly hospitalized patients with inflammatory bowel disease (IBD) flare and concurrent Clostridioides difficile infection (CDI) are considered at high risk of IBD-related complications. We aimed to evaluate the short-,intermediate-, and long-term post-discharge complications among these patients.

METHODS

A retrospective multicenter cohort study assessing outcomes of elderly individuals (≥60 years) hospitalized for an IBD flare who were tested for CDI (either positive or negative) and discharged. The primary outcome was the 3-month post-discharge IBD-related complication rates defined as steroid dependency, re-admissions (emergency department or hospitalization), IBD-related surgery, or mortality. We assessed post-discharge IBD-related complications within 6 month and mortality at 12 month among secondary outcomes. Risk factors for complication were assessed by multivariable logistic regression.

RESULTS

In a cohort of 654 patients hospitalized for IBD {age 68.9 (interquartile range [IQR]): 63.9-75.2 years, 60.9% ulcerative colitis (UC)}, 23.4% were CDI-positive. Post-discharge complication rates at 3 and 6 months, and 12 months mortality, did not differ significantly between CDI-positive and CDI-negative patients (32% vs 33.1%, p = 0.8; 40.5% vs 42.5%, p = 0.66; and 4.6% vs 8%, p = 0.153, respectively). The Charlson comorbidity index was the only significant risk factor for complications within 3 months (aOR 1.1), whereas mesalamine (5-aminosalicylic acid [5-ASA]) use was protective (aOR 0.6). An UC diagnosis was the sole risk factor for complication at 6 months (aOR 1.5). Clostridioides difficile infection did not significantly impact outcomes or interact with IBD type.

CONCLUSIONS

In elderly IBD patients hospitalized for IBD flare and subsequently discharged, a concurrent CDI infection was not associated with post-discharge IBD-related complications or mortality up to 1 year.

摘要

目的

老年炎症性肠病（IBD）发作并同时合并艰难梭菌感染（CDI）的住院患者被认为有发生IBD相关并发症的高风险。我们旨在评估这些患者出院后的短期、中期和长期并发症。

方法

一项回顾性多中心队列研究，评估因IBD发作住院且接受CDI检测（阳性或阴性）并出院的老年患者（≥60岁）的结局。主要结局是出院后3个月的IBD相关并发症发生率，定义为类固醇依赖、再次入院（急诊科或住院）、IBD相关手术或死亡。我们评估了次要结局中6个月内出院后IBD相关并发症及12个月时的死亡率。通过多变量逻辑回归评估并发症的危险因素。

结果

在654例因IBD住院的患者队列中（年龄68.9岁[四分位间距（IQR）]：63.9 - 75.2岁，60.9%为溃疡性结肠炎（UC）），23.4%为CDI阳性。CDI阳性和CDI阴性患者在出院后3个月和6个月的并发症发生率以及12个月的死亡率无显著差异（分别为32%对33.1%，p = 0.8；40.5%对42.5%，p = 0.66；4.6%对8%，p = 0.153）。Charlson合并症指数是3个月内并发症的唯一显著危险因素（校正比值比[aOR]1.1），而使用美沙拉嗪（5-氨基水杨酸[5-ASA]）具有保护作用（aOR 0.6）。UC诊断是6个月时并发症的唯一危险因素（aOR 1.5）。艰难梭菌感染对结局无显著影响，也不与IBD类型相互作用。