Mortality twice as high for patients with IBD, non-STEMI vs. IBD alone
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DENVER — Patients with inflammatory bowel disease and non-ST elevation myocardial infarction had higher mortality, hospital stays and hospital charges than patients with IBD alone, noted a presenter at the Crohn’s and Colitis Congress.
“Based on our study results, IBD patients with non-STEMI require closer monitoring, and there needs to be a focus on better treatment and preventing complications that may develop,” Neethi R. Dasu, DO, from the Rowan University School of Osteopathic Medicine, told Healio. “Furthermore, our study revealed these patients with IBD are at an increased risk for cardiovascular events.”
As a GI and cardiology fellow, respectively, Dasu and her colleague Yaser Khalid, MD, from the Wright Center for Graduate Medical Education, had previously noted that many patients with IBD often exhibited concomitant troponin elevation/non-STEMI, and that the care of these patients was often delayed.
To determine the impact of concomitant non-STEMI and IBD on the health care system, Dasu and colleagues used the Nationwide Inpatient Sample from 2015 to 2019 to identify patients with IBD and non-STEMI (n = 89,460) vs. patients with IBD alone (n = 447,300). The researchers applied multivariate regression analysis to estimate the odds ratios of in-hospital mortality, average length of hospital stay and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size, hospital region, hospital teaching status and other demographic characteristics.
According to study results, mortality (OR = 2.16; 95% CI, 1.29-3.66), hospital length of stay (+2.25; 95% CI, 0.82-3.67) and total hospital charges were all higher ($42,710.89; 95% CI, $21,379.01-$64,042.77) for patients with IBD and non-STEMI vs. patients with IBD alone.
“Aside from patients with both comorbidities having increased length of stay, total hospital charges and twice as high mortality compared to just patients with IBD, the more interesting findings were the independent positive predictors of increased mortality, length of stay and total hospital charges,” Dasu said. “These included sepsis, [acute kidney injury], malnutrition and aspiration events. This is interesting because it highlights the need for clinicians to be diligent in monitoring for these potential complications; early intervention and treatment could definitely change outcomes and diminish mortality, morbidity and costs.”
The researchers noted that since common and overlapping inflammatory pathways contribute to that both IBD and non-STEMI — likely increasing the risk for complications and mortality — a multidisciplinary approach should be employed with these patients, focused on the identification and mitigation of cardiovascular risk factors, as well as remission of IBD/disease activity.
“Clinicians should be aware of complications that worsen outcomes in patients with inflammatory bowel disease and non-STEMI,” Dasu said. “Early monitoring for the development of sepsis, acute kidney injury or aspiration can significantly alter outcomes in these patients.”
She added: “We identified malnutrition as a predictor for worsened mortality, length of stay and hospital charges. Malnutrition affects a large percentage of patients with IBD, and its presence worsens outcomes in patients that have non-STEMI; thus, early initiation of nutrition, monitoring for malnutrition and involvement of dietitians can improve outcomes.”
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Suga H. Poster P003: Impact of non-ST-elevation myocardial infarction (NSTEMI) on patients with inflammatory bowel disease. Presented at: Crohn’s and Colitis Congress; Jan.19-21, 2023; Denver (hybrid meeting).
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