Elida Voth, MD1, Dipesh Solanky, MD2, Edward V. Loftus, Jr., MD, FACG1, Darrell Pardi, MD, MS, FACG1, Sahil Khanna, MBBS, MS1
1Mayo Clinic, Rochester, MN; 2University of California San Diego, San Diego, CA
Introduction: Patients with inflammatory bowel disease (IBD) are at significantly increased risk for Clostridium difficile infection (CDI). CDI in IBD is associated with increased in-hospital mortality, IBD treatment failure, re-hospitalization and high CDI recurrence rates. The existing literature on predictors of these adverse outcomes is limited. We evaluated four potentially modifiable novel risk factors (BMI, statin use, opioid use, and antidepressant use) on the risk and outcomes of CDI in patients with IBD.
Methods: CDI disease severity and other clinical outcomes, including colon surgery, CDI recurrence, CDI-related hospitalization, IBD exacerbations, and mortality were abstracted using the electronic medical record. Additionally, variables including BMI, statin use, opioid use, and antidepressant use at the time of CDI were abstracted from records for patients with IBD and CDI from 2008 and 2013. Statistical analysis comprised of descriptive statistics and univariate and multivariate logistic regression analyses.
Results: There were 137 patients with IBD and CDI included in this study: 70 with ulcerative colitis (51%), 63 with Crohn’s disease (46%), and 4 with indeterminate colitis (3%). The median age was 46 years, and 55% were female. On multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe complicated CDI, compared to 22% of patients in the underweight/normal BMI (OR, 2.85, p=0.02) and 19% in the obese category (OR, 3.95, p=0.04). Statin use was associated with severe or severe complicated CDI when controlling for age and BMI (OR, 5.66, p=0.01). On multivariate analysis controlling for age and CDI severity, there was no association between statin use and post-CDI IBD exacerbations. Opioid and antidepressant use were not associated with CDI disease severity or IBD exacerbations. BMI category, statin use, opioid use, and antidepressant use were not associated with colon surgery, CDI recurrence, CDI-related hospitalizations, or mortality at 1 year.
Discussion: An overweight BMI and statin use were associated with severe or severe complicated CDI. There was no association between statin use and IBD exacerbations following CDI. Opioid and antidepressant use were not associated with disease severity or frequency of IBD exacerbations following CDI. Further studies are needed to better understand how these results could impact management of patients with IBD to improve clinical outcomes and potentially reduce the risk of CDI.
Citation: Elida Voth, MD; Dipesh Solanky, MD; Edward V. Loftus, Jr., MD, FACG; Darrell Pardi, MD, MS, FACG; Sahil Khanna, MBBS, MS. P1401 - NOVEL RISK FACTORS AND OUTCOMES IN INFLAMMATORY BOWEL DISEASE PATIENTS WITH CLOSTRIDIUM DIFFICILE INFECTION. Program No. P1401. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.