Opioid Treatment, Low BMI Linked to Severe Infection in Patients with IBD

Matthew Lyons, MBChB

A recent study presented at the 2021 Digestive Disease Week Virtual Meeting found that patients with inflammatory bowel disease (IBD) deal with a significant burden of infection and it is the most common reason for admission into the hospital and intensive care unit (ICU).

Investigators, led by Matthew Lyons, MBChB, Western General Hospital, examined data on hospital admission with infection in patients with IBD, correlated to IBD treatment over a 10-year period.

Study

Lyons and colleagues collected data on patients with IBD through the Lothian IBD Registry (LIBDR), with a population of 900,000 in the NHS Lothian capture area.

The pre-existing databases and electronic health records were then linked by a community health index (CHI) number.

Admissions were included between January 2010 and December 2019, with admissions with <24-hour duration excluded from the study.

Investigators recorded diagnosis codes through the ICD-10 system, while primary care prescription data was recorded using British National Formulary (BNF) codes. Secondary care registries had biologic prescribing data available.

The team used Cox Proportional Hazard models to perform logistic regression.

They identified risk factors predicting death or admission to intensive care due to infection following admission.

Results

Investigators found 17,221 non-day case hospital admissions for 4660 of 8381 patients in the LIBDR prevalent cohort, during the study period.

They found that 2964 admissions for 1489 patients were for an infection. They noted that respiratory, urinary tract, and gastrointestinal infections accounted for nearly 75% of infection admissions. There were no differences found between sex and diagnosis.

A total of 88 admissions to the ICU were due to infection, with 79 patients with respiratory infection being the most prevalent.

Further, Investigators noted that 119 patients who died within 30 days of admission for infection had infection listed on their death certificate.

In 1,511 of hospital admissions, patients had attended a secondary care IBD clinic in the prior 18 months.

Lyons and colleagues also found a primary care prescription for steroids, opioids, thiopurines, or antibiotics were issued within 90 days preceding 2236 admissions for injection.

They noted that 184 patients were on biologic therapy at the time of ICU admission and an overall 10-fold increase in biologic prescriptions in the past 10 years.

The team also found positive blood culture (odds ratio (OR) 6.02, P <.001), opioid therapy (OR 3.08, P = .014), and being underweight (OR 2.61, P = .003) were predictive of poor outcomes for patients.

However, secondary care follow-up for IBD was protective (OR 0.62, P = .049), while biologic therapy was not associated with risk of ITU admission or death due to infection.

Conclusion

Investigators concluded that patients with IBD had a significant burden of infection.

“There is a significant burden of infection in the IBD population, and it is the most common reason for their admission,” investigators wrote. “Opioid therapy and low body mass index are independent predictors of severity of infection.”

The study, “Opioids and Low BMI But Not Biologics Predict Severe Infection in IBD Patients: A 10 Year Population Based Cohort Study,” was presented online at DDW 2021.