Sninsky Jared A, Brooks Carolyn, Sansgiry Shubhada, Shukla Richa, Subramanian Stalin, Hou Jason K
VA Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.
Crohns Colitis 360. 2025 Mar 4;7(3):otaf012. doi: 10.1093/crocol/otaf012. eCollection 2025 Jul.
Anemia is a common complication of inflammatory bowel disease (IBD), impacting patient quality of life and clinical outcomes. This study examines anemia management practices and clinical outcomes in a national cohort of veterans with IBD.
A retrospective cohort study of 89 687 veterans with IBD from 2000 to 2017 was conducted using Veterans Health Administration data. We assessed anemia screening, iron store assessments, and iron therapy. Primary outcomes included anemia resolution within 12 months. Secondary outcomes included IBD-related hospitalizations, steroid use, and surgery within five years. Multivariate logistic regression models assessed associations between patient characteristics and clinical outcomes.
Among 89 687 VA patients with IBD, 56% experienced anemia, but only 36% received iron testing. Only 23% of patients with iron deficiency received iron therapy within 6 months. Hemoglobin normalization occurred in 19% within a year. IBD patients with comorbidities had lower resolution rates (1-2 comorbidities: OR 0.89). Over five years, 30% were hospitalized, with lower rates for nonsmokers (OR 0.81) and higher for those with comorbidities (OR 1.10) or on biologics (OR 1.91). Steroid use was 17.5%, higher in those with comorbidities (OR 1.20) or on biologics (OR 4.11), and lower in Black patients (OR 0.78). Only 2% had surgery, less common among Black patients (OR 0.69) and non-smokers (OR 0.72).
Anemia is underdiagnosed and undertreated in veterans with IBD, leading to poor clinical outcomes. Enhanced screening and treatment protocols are essential to improve anemia resolution rates and reduce IBD-related complications.
贫血是炎症性肠病（IBD）的常见并发症，会影响患者的生活质量和临床结局。本研究调查了一组全国性IBD退伍军人队列中的贫血管理措施及临床结局。
利用退伍军人健康管理局的数据，对2000年至2017年间89687名患有IBD的退伍军人进行了一项回顾性队列研究。我们评估了贫血筛查、铁储备评估和铁剂治疗情况。主要结局包括12个月内贫血症状缓解。次要结局包括五年内与IBD相关的住院治疗、类固醇使用情况及手术情况。多变量逻辑回归模型评估了患者特征与临床结局之间的关联。
在89687名患有IBD的退伍军人事务部患者中，56%出现贫血，但只有36%接受了铁检测。缺铁患者中只有23%在6个月内接受了铁剂治疗。一年内血红蛋白恢复正常的患者占19%。患有合并症的IBD患者缓解率较低（1 - 2种合并症：比值比0.89）。在五年时间里，30%的患者住院，其中不吸烟者住院率较低（比值比0.81），而患有合并症者（比值比1.10）或使用生物制剂者（比值比1.91）住院率较高。类固醇使用率为17.5%，患有合并症者（比值比1.20）或使用生物制剂者（比值比4.11）的使用率较高，而黑人患者的使用率较低（比值比0.78）。只有2%的患者接受了手术，在黑人患者（比值比0.69）和不吸烟者（比值比0.72）中手术情况较少见。
IBD退伍军人中贫血的诊断和治疗不足，导致临床结局不佳。加强筛查和治疗方案对于提高贫血缓解率和减少与IBD相关的并发症至关重要。
