OPIOIDS AND LOW BMI BUT NOT BIOLOGICS PREDICT SEVERE INFECTION IN IBD PATIENTS: A 10 YEAR POPULATION BASED COHORT STUDY

ABSTRACT

Introduction: Many patients with Crohn’s disease (CD) and ulcerative colitis (UC) require immunosuppressant therapies. There is an established increased risk of infection with these therapies, especially when used in combination. COVID-19 has further focused attention on risk of therapy and infection;in particular risks of intensive care unit (ICU) stay and death. We examined data on immunosuppressant medications, hospital admissions, ICU admission and death in our population-based database in the 10 years immediately prior to COVID-19.Methods: The Lothian IBD Registry (LIBDR) contains an accurate record of all prevalent IBD patients in the NHS Lothian capture area (population 900,000) [1]. Pre-existing databases and electronic health records were linked by community health index (CHI) number, a unique identifier covering 100% of the population, for admissions between 01/01/2010 and 31/12/2019. All admissions <24hour duration were excluded. All diagnosis codes were recorded using the ICD-10 system. Primary care prescription data was recorded using British National Formulary (BNF) codes. Biologic prescribing data was available from secondary care registries. Logistic regression using Cox Proportional Hazards model was used to identify risk factors predicting death or admission to intensive care due to infection following admission for an infection.Results: There were 17,221 non-day case hospital admissions for 4,660 of the 8,381 patients in the LIBDR prevalent cohort in the study period. 2,964 of these admissions for 1,489 patients were for an infection. Respiratory, urinary tract and gastrointestinal infections accounted for almost 75% of infection admissions with no differences between sex or diagnosis. There were 88 admissions to ICU due to infection for 79 patients with respiratory infection being the most common. There were 119 patients who died within 30 days of an admission for infection who had an infection listed on their death certificate. For 1,511 of the admissions, the patient had attended a secondary care IBD clinic within the preceding 18 months. A primary care prescription for steroids, opioids, thiopurines or antibiotics was issued within 90 days preceding 2,236 admissions for infection. 184 patients were on biologic therapy at the time of ITU admission or death. Positive blood cultures (OR 6.02, p<0.001), opioid therapy (OR 3.08, p=0.014) and being underweight (OR 2.61, p=0.003) were predictive of poor outcome while attending secondary care follow up for IBD was protective (OR 0.62, p=0.049). Biologic therapy was not associated with risk of ITU admission or death due to infection.Conclusions: There is a significant burden of infection in the IBD population and it is the most common reason for their admission. Opioid therapy and low body mass index are independent predictors of severity of infection. 1 Jones, G.R. et al. Gut (2019)(Figure presented)