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P291. Factors associated with premature death in inflammatory bowel disease

A.M. O'Toole, D. Keegan, D. O'Donoghue, H. Mulcahy, G.A. Doherty

St Vincent's University Hospital, Centre for Colorectal Disease, Dublin, Ireland

Introduction: Crohn's disease (CD) and Ulcerative Colitis (UC) are associated with significant morbidity with less attention paid to mortality however evidence suggests a small but significant increase in mortality associated with Inflammatory Bowel Disease (IBD).

Aims: To examine mortality rates and factors related to survival in patients with IBD in an Irish tertiary referral centre.

Methods: Forty-nine patients with inflammatory bowel disease who died under the age of sixty-five were identified from a large prospectively maintained IBD database. The cause of death was recorded as the medical cause of death stated in the death certificates obtained from the Irish registry office of births, marriages and deaths.

Results: Two thousand two hundred and seventy-five patients diagnosed with IBD before the age of 65 were identified corresponding to 21,571 years follow up and mean follow up of 9.48 years. Forty-nine patients died before their 65th birthday, representing 2.15%. Mean age of death was 42.9 years (range 16–64). Cause of death included 14 from sepsis (13 CD), 7 from colorectal carcinoma (4 UC), 3 from cholangiocarcinoma (3 UC), 10 other malignancies (6 CD) including 3 lymphomas and 2 from self harm. Mortality was not associated with gender (p = 0.02), biologic or immunomodulator therapy (p = 0.63) or disease type (p = 0.22).

In total 860 patients had previous resection surgery, with 31 total deaths in contrast to 18 deaths from a total of 1415 surgery naive patients (p = 0.04). Death directly related to disease occurred in 16 patients who underwent prior resection compared to 2 deaths directly related to disease in patients with no prior surgery (p = 0.001).

Conclusions: Previous surgical resection was significantly associated with an increased risk of premature mortality in IBD patients, which likely reflects the severity of the underlying disease. Sepsis was the main cause of death in patients with CD with carcinoma a major cause of death in UC.