Higher Mortality for Patients with IBD and Concomitant Cardiovascular Conditions - EMJ

Higher Mortality for Patients with Irritable Bowel Disease and Concomitant Cardiovascular Conditions

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HIGHER mortality, hospital stays, and hospital charges were observed in patients with irritable bowel disease (IBD) and non-ST elevation myocardial infarction (STEMI), compared to IBD alone. Neethi Dasu, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA, co-author in the study, highlighted the importance and action that should be taken on the back of this investigation: “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.”

Dasu and their colleague Yaser Khalid, Wright Centre for Graduate Medical Education, Jermyn, Pennsylvania, USA, noted that many patients with IBD exhibit concomitant troponin elevation and non-STEMI, and that the care for these patients is often delayed. Using the Nationwide Inpatient Sample from 2015–2019, in order to determine the impact of concomitant non-STEMI and IBD on the healthcare system, they applied a multivariate regression analysis to their cohort of patients with IBD and non-STEMI (n=89,460) versus patients with IBD alone (n=447,300). Their analysis estimated the odds ratios of in-hospital mortality, average length of hospital stay, and hospital charges, adjusting for a host of factors, including age, gender, race, and other demographic characteristics. Mortality (odds ratio: 2.16; 95% confidence interval [CI]: 1.29–3.66), hospital length of stay (+2.25; 95% CI: 0.82–3.67), and total hospital charges (42,710.89 USD; 95% CI: 21,379.01–64,042.77 USD) were all higher for patients with IBD and non-STEMI versus patients with IBD alone.

Key findings from this study are set to impact practice and are summarised in the following statement by Dasu, speaking about the independent positive predictors (sepsis, acute kidney injury, malnutrition, and aspiration events) of increased mortality, length of stay, and charges: “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 also noted that, due to common and overlapping inflammatory pathways contributing to IBD and non-STEMI likely increasing the risk for complications and mortality, a multidisciplinary approach should be employed, focusing on identification and mitigation of cardiovascular risk factors, as well as IBD remission. Dasu observed: “Early monitoring for the development of sepsis, acute kidney injury, or aspiration can significantly alter outcomes in these patients.” Speaking about malnutrition as a predictor,” they added, “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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