Mortality among patients with ulcerative colitis (UC) or Crohn disease (CD) was independently associated with increased age (>65 years), according to results of a study published in the Journal of Clinical Gastroenterology.
Investigators from Beth Israel Deaconess Medical Center and Harvard Medical School sourced data from the National Inpatient Sample (NIS), which includes records from 20% of all hospitals in the United States. Admissions for UC (n=96,450) or CD (n=162,800) between 2016 and 2017 were assessed for mortality risk on the basis of age.
Among hospital admissions, 30% of the UC and 20% of the CD cohorts were classified as geriatric. The geriatric populations had increased comorbidities, more instances of Clostridioides difficile infection, fewer had surgery, and they had longer hospital stays.
The average hospital stay was 0.19 (P =.009) and 0.11 (P =.271) days longer among the geriatric cohort, increasing costs by an average of $2467 (P =.012) and $1533 (P =.302) for the CD and UC cohorts, respectively.
Mortality was increased among the geriatric population with CD (3.9% vs 0.5%; P <.001) and UC (5.0% vs 1.0%; P <.001). Among the CD cohort, mortality occurred at similar rates for the geriatric and nongeriatric cohorts, specifically due to infection or sepsis (78.6% vs 80.1%), disease-related complications (15.6% vs 14.9%), and other causes (5.8% vs 5.0%), respectively. A similar pattern was observed for the UC cohort with little differences for mortality due to infection or sepsis (79.2% vs 85.1%), disease-related complications (16.7% vs 12.7%), and other causes (4.1% vs 2.2%).
Mortality among the patients with CD was associated with perforation (adjusted odds ratio [aOR], 6.39; 95% CI, 3.88-10.52; P <.001), age >65 years (aOR, 3.47; 95% CI, 2.72-4.44; P <.001), Clostridioides difficile infection (aOR, 1.69; 95% CI, 1.10-2.60; P =.018), Elixhauser Mortality Index (aOR, 1.11; 95% CI, 1.10-1.12; P <.001), fistula (aOR, 0.57; 95% CI, 0.34-0.95; P =.031), obstruction (aOR, 0.45; 95% CI, 0.33-0.61; P <.001), and abscess (aOR, 0.36; 95% CI, 0.20-0.66; P <.001).
Predictors of mortality among the UC cohort included perforation (aOR, 3.98; 95% CI, 2.15-7.38; P <.001), age >65 years (aOR, 2.75; 95% CI, 2.16-3.49; P <.001), Clostridioides difficile infection (aOR, 2.38; 95% CI, 1.82-3.12; P <.001), Elixhauser Mortality Index (aOR, 1.11; 95% CI, 1.10-1.12; P <.001), and bleeding (aOR, 0.66; 95% CI, 0.52-0.85; P =.001).
This study was limited by lack of access to individual clinical information. Additionally, investigators were unable to adjust for frailty.
The study authors concluded that increased age was an independent predictor for mortality among inpatients with UC or CD. Additional study is needed to determine mechanisms for decreasing infection-related mortality among these patients.
Schwartz J, Stein DJ, Lipcsey M, Li B, Feuerstein JD. High rates of mortality in geriatric patients admitted for inflammatory bowel disease management. J Clin Gastroenterol. 2022;56(1):e20-e26. doi:10.1097/MCG.0000000000001458