P323 Risk factor analysis for therapy related adverse events and infections in elder patients with Inflammatory Bowel Disease; An analysis from the IG-IBD aged study
A. Ferrara*1, A. Viola1, N. Mannetti2, M. Coppola2, I. Frankovic3, R. Monterubbianesi4, D. Pugliese5, A. Aratri6, M. Cappello7, G. Costantino1, S. Saibeni8, M. Principi9, F. Furfaro10, G. Fiorino11, G. Mocci12, F. Castiglione13, G. Scalisi14, F. Callela15, A. Magarotto16, F. Caprioli16, G. Casella17, L. Samperi18, A.C. Privitera19, G. Inserra18, S. Danese11, S. Ardizzone10, C. Papi6, A. Armuzzi5, 20, A. Kohn4, F. Bossa14, R. D'Incà3, V. Annese2, A. Alibrandi21, W. Fries1
1University of Messina, Dept. of Clinical and Experimental Medicine, Messina, Italy, 2Careggi, University Hospital, Gastroenterology Unit, Firenze, Italy, 3University of Padua, Department of Surgery, Oncology and Gastroenterology, Padua, Italy, 4A.O.San Camillo Forlanini, Gastroenterology Unit, Rome, Italy, 5Catholic University, IBD Unit, Complesso Integrato Columbus, Rome, Italy, 6A.O.San Filippo Neri, Gastroenterology and Hepatology Unit, Rome, Italy, 7A.O.U. Policlinico, UOC Gastroenterologia ed Epatologia, Palermo, Italy, 8AO Fatebenefratelli e Oftalmico, UOC di Medicina Interna ed Epatologia, Milano, Italy, 9University of Bari, Gastroenterology Section (D.E.T.O.), Bari, Italy, 10Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy, 11Humanitas Research Hospital, IBD Center, Dept. of Gastroenterology, Rozzano, Milan, Italy, 12Azienda Ospedaliero Universitaria di Cagliari, Gastroenterology, Cagliari, Italy, 13Seconda Università di Napoli, Gastroenterology, Napoli, Italy, 14IRCCS “Casa Sollievo della Sofferenza”, Div of Gastroenterology, San Giovanni Rotondo (FG), Italy, 15Ospedale San Giuseppe, UOC Gastroenterologia, Empoli (FI), Italy, 16Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy, 17Ospedale Desio,, Dipartimento di Medicina, Desio (MB), Italy, 18University of Catania, Dip. di Scienze Mediche e Pediatriche, UO Medicina Interna, Catania, Italy, 19Azienda Ospedaliera per l'Emergenza , Gastroenterology, Catania, Italy, 20Catholic University, Rome, Complesso Integrato Columbus, IBD UNIT, Roma, Italy, 21University of Messina, Department of Economical, Financial, Social, Environmental, Statistical and Territorial Sciences, Messina, Italy
Background
Elder people with inflammatory bowel disease present problems related to concomitant pathologies and to a worse outcome compared to younger patients in case of infections. The AGED study (Assessment of IBD in the Geriatric patients and Evolution of Disease) is based on a retrospective data collection on the first 3-years period following diagnosis in different age groups.
Infections, Hospitalizations and AEs in the different age groups
| Group 1 n=433 | Group 2 n=450 | Group 3 n = 840 | p-value | |
|---|---|---|---|---|
| INFECTIONS Infections total, % | 9.0 | 5.6 | 8.9 | 0.058 |
| Hospitalization due to infections, % | 38.5 | 36 | 16 | 0.529 |
| HOSPITALIZATIONS IBD-related, % | 37 | 37.1 | 35.9 | 0.442 |
| Length of stay; days mean ± SE | 13.7 ± 0.7 | 12.1 ± 0.6 | 12.2 ± 0.4 | 0.031 |
| IBD-unrelated, % | 9.0 | 5.1 | 3.3 | 0.000 |
| AE from steroids, % | 2.1 | 3.7 | 1.5 | 0.122 |
| AE from IMM; % | 28.8 | 26 | 21.1 | 0.348 |
| Ae from BIO,% | 8 | 7 | 11 | 0.127 |
| Moderate permanent damage from AE | 12.8 | 4.4 | 0.8 | 0.003 |
Methods
The database includes 1723 patients with 433 diagnosed over age 65 years (group 1: UC 280, CD 153, males 231), 450 patients between 40 - 65 years (group 2: UC 289, CD 161, males 271), and 840 patients diagnosed before age 40 years (UC 523, CD317, males 438); data on therapy steroids, S, immunomodulators, IMM, and biologics, BIO), adverse events (AEs) and their outcome (mild or moderate permanent damage), IBD-related and -unrelated hospitalizations and on infections were extracted together with the Charlson comorbidity score (CCS), and concomitant therapies (antihypertensives, AH, proton pump inhibitors, PPI, antidiabetics, AD, antithrombotics, AT).
Results
therapy with 5-.ASA and S was similar in all groups; significantly more IMM (p<0.001) and BIO (p<0.001) were used in group 3; the number ofr AEs were similar in the 3 groups;
reports Aes related to different therapies, as well as AEs requiring hospitalizations. Mild (p<0.045) or moderate (p<0.003) permanent damage from AEs was more frequently observed in group 1 and 2. IBD-related hospitalizations in the first 3 years were not significantly different in the 3 groups, whereas IBD-unrelated hospitalizations were more frequent in group 1 and 2.
Univariate analysis identified CCS (OR: 1.418; 95%CI 1.053-1.909; p<0.021), the use of 2 (OR: 1.738; 95%CI 1.185-2.550; p<0.005) or 3 (OR: 3.065 (95%CI 1.665-5.645, p< 0.000) immunosuppressants (IMSs), PPI use (OR: 1.727; 95%CI 1.005-2-967, p<0.048), and AT use (OR: 2.143; 95%CI 1.272-3.611; p<0.004) as risk factors for infections.
Risk factors for AEs were the use of 2 (OR: 3.880; 95%CI 2.857-5.270; p<0.000) or 3 (OR: 4.231 (95%CI 2.556-7.004, p< 0.000) IMSs; interestingly the use of a single IMS represented a protective factor against AEs (OR: 0.443; 95%CI 0.317-0.619; p<0.000).
Conclusion
Although numerically not different from younger age groups AEs leading to permanent damage were more frequently observed in the older age groups of IBD patients. The length of hospital stays due to infections was significantly increased in elder patients. Risk factors for infections were the association of 2 or more IMSs, as well as concomitant pathologies, PPI and AT use.