Morbidity and Mortality Higher in Ulcerative Colitis Patients with Infections

Frank Senatore, MD

In developed countries throughout the world, including the US, the incidence of ulcerative colitis (UC) is rising, creating a substantial economic burden, especially when that burden is coupled with a Clostridium difficile (C. diff) or cytomegalovirus (CMV) infection.

In research presented as a poster at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019), a team of investigators, led by Frank Senatore, MD, Rutgers Robert Wood Johnson Medical School, found that ulcerative colitis patients with C. diff infections have a higher morbidity and mortality than the patients with just ulcerative colitis flares.

The investigators used data from the 2011-2014 Nationwide Inpatient Sample (NIS) for the retrospective cohort study, specifically utilizing the International Classification of Diseases, 9^th Revision. Additional codes were utilized to identify CMV associated disease and presence of C. diff in the ulcerative colitis cohort.

For the study, the investigators compared the rates of colectomy, length of hospital stays, as well as inpatient mortality in ulcerative colitis patients admitted with flares to ulcerative colitis patients admitted with flares associated with either CMV or C. diff infections.

The study included adult patients with principal or secondary discharge diagnoses of ulcerative colitis.

The investigators compared proportions using fisher’s exact test and continuous variables using student t-test and performed multivariable and Poisson regression for length of stay and hospitalization changes.

All of the statistics in the study were performed utilizing STATA software.

The investigators broke down the findings based on demographic lines.

“There were no gender differences between the 3 cohorts while the mean age of UC patients with CMV was 42.94 years compared to 46.96 and 46.63 years in UC flare and UC patients with C. diff, respectively,” the authors wrote. “Hispanics were more commonly found to have UC with CMV associated disease (14.07%) vs UC flare (9.61%) and UC with C. diff (10.59%) (P =.001).”

Steroid dependency was also found in 6.53% of ulcerative colitis patients in the study, 10.11% of C. diff patients, and 18.11% of CMV flares (P =.001). Colectomy rates were 1.71% for ulcerative colitis, 3.99% for C. diff, and 9.98% for CMV cohorts.

The length of stays were 4.71 days in ulcerative colitis, 7.28 days in C. diff, and 11.47 days in CMV flares (P =.001).

In-patient mortality was 0.3%, 1.31% and 0.55% for UC, C. diff and CMV cohorts, respectively (P =.00001).

Both C. diff and CMV infections are linked to a poorer prognosis, particularly with immunocompromised patients.

“This study demonstrates that patients admitted with UC flares associated with C. diff or CMV infection have higher morbidity and mortality than patients with UC flares alone,” the authors wrote. “Immunocompromised patients should warrant a higher index of suspicion for these infections.”

The poster, “Comparison of Morbidity and Mortality in Ulcerative Colitis Patient Admissions With Cytomegalovirus and Clostridium difficile Infections,” was presented Sunday, October 27, 2019, at the American College of Gastroenterology Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.