High Rates of Mortality in Geriatric Patients Admitted for Inflammatory Bowel Disease Management

Schwartz, J. Sanford; Stein, Daniel J.; Lipcsey, Megan; Li, Brian; Feuerstein, Joseph D.

doi:10.1097/mcg.0000000000001458

Cited by 9 publications

(6 citation statements)

References 40 publications

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“…It has been estimated that 25–30% of the IBD population are aged 60 or older, 26 making this predictor even more clinically relevant. Among inpatients, the elderly are at higher risk of poor outcomes, 4 , 27 with advanced age (≥ 65) being associated with increased inpatient mortality in IBD. 4 , 6 , 27 Interestingly, immunosuppression was not a predictor for inpatient mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Among inpatients, the elderly are at higher risk of poor outcomes, 4 , 27 with advanced age (≥ 65) being associated with increased inpatient mortality in IBD. 4 , 6 , 27 Interestingly, immunosuppression was not a predictor for inpatient mortality. While this may be due to under‐documentation and/or absolute small numbers of immunosuppressed patients ( n = 63 among 1294 deaths), the preponderance of data suggests that patient‐related factors impacted outcomes more than medication use.…”

Section: Discussionmentioning

confidence: 99%

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Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach

Charilaou

Mohapatra

Doukas

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine-learning (ML). Methods: Using the National Inpatient Sample (NIS) database (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), we extracted adults admitted for IBD. After ML-guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR) ≥ 80% and ≥ 3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD-related surgery sub-cohort. External validation was done using NIS 2018. Results: In 398 426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n = 40 784). Increasing age, ulcerative colitis, IBD-related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0-3.3; area-under-curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6-fold when comparing high to low-risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49-fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im-ibd/) was developed allowing bedside model predictions. Conclusions: An online prediction-model calculator captured > 80% IM cases during personal conflict of interest to disclose. Arkady Broder has no financial or personal conflict of interest to disclose. Olivier Elemento discloses grant support from Janssen, Johnson and Johnson, Volastra Therapeutics, AstraZeneca and Eli Lilly research grants as well as membership to scientific advisory board and equity holding in Freenome, Owkin, Volastra Therapeutics and One Three Biotech. Dana Lukin discloses consulting for Abbvie,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach

Charilaou

Mohapatra

Doukas

et al. 2022

J of Gastro and Hepatol

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“…Independently from age, mortality in UC after the first year from diagnosis appears to be similar to that of the general population [ 117 ], but frailty [ 24 ], steroid use [ 118 ], infections [ 119 ], and surgery-related complications [ 27 ] remain the major drivers for adverse outcomes.…”

Section: Therapy-related Risks In Older Patients With Ucmentioning

confidence: 99%

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

et al. 2022

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The number of patients with inflammatory bowel disease (IBD) approaching an older age, together with the number of over-60-year-old patients newly diagnosed with IBD, is steadily increasing, reaching 25% of all patients. The present review focuses on late-onset ulcerative colitis (UC) and its initial disease course in comparison with that observed in younger adults in terms of extension at onset and the risk of proximal disease progression, medical treatment, surgery and hospitalization in the first years after diagnosis. We summarize the clues pointing to a milder disease course in a population which frequently presents major frailty due to comorbidities. With increasing age and thus increasing comorbidities, medical and surgical therapies frequently represent a challenge for treating physicians. The response, persistence, and risks of adverse events of conventional therapies indicated for late onset/older UC patients are examined, emphasizing the risks in this particular population, who are still being treated with prolonged corticosteroid therapy. Finally, we concentrate on data on biotechnological agents for which older patients were mostly excluded from pivotal trials. Real-life data from newer agents such as vedolizumab and ustekinumab show encouraging efficacy and safety profiles in the population of older UC patients.

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“…[18][19][20][21][22] Studies centered on elderly IBD patients repeatedly found increased mortality rates. 10,23,24 Studies on the Inflammatory Bowel South-Eastern Norway [IBSEN] cohort detected a small but not significant increase in mortality 20 years after diagnosis. 25,26 While the proportion of elderly patients in this cohort has grown, the aims of this study were primarily to determine the hazard ratios [HRs] for mortality within 30 years following diagnosis, and secondarily to identify specific causes of mortality and subgroups of patients most at risk.…”

Section: Inflammatory Bowel Diseases [Ibd] Including Crohn's Diseasementioning

confidence: 99%

“… 18–22 Studies centered on elderly IBD patients repeatedly found increased mortality rates. 10 , 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study)

Follin-Arbelet

Milada

Hovde

et al. 2022

Journal of Crohn's and Colitis

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Background and aims Patients with longstanding inflammatory bowel disease (IBD) may be at an increased risk of death compared to the general population, especially elderly patients. The Inflammatory Bowel South-Eastern Norway (IBSEN) study has previously detected a small but not statistically significant increase in mortality, 20 years after diagnosis. The aim of this study was to evaluate the overall and cause-specific mortality at 30 years of follow-up. Methods The IBSEN cohort included 519 incident patients with ulcerative colitis (UC) and 237 patients with Crohn’s disease (CD) between 1990 and 1993, each matched with five controls. Death certificate data were obtained from the Norwegian Cause of Death Registry. The underlying causes of death were categorised into five groups: all cancers, gastrointestinal cancers, cardiovascular diseases, infections, and all other causes. Hazard ratios (HR) were modelled using Cox regression. Results There was no statistically significant difference in the overall mortality rates. However, in patients with CD, male sex (HR = 1.65 [1.04-2.62]), onset after 40 years of age (HR = 1.72 [95% CI: 1.19-2.48]), colonic disease (HR = 1.57 [1.05-2.35]), and penetrating behavior (HR = 3.3 [1.41-7.76]) were clinical factors associated with an increased mortality. IBD patients were at a higher risk of death due to cardiovascular disease; HR = 1.51 [1.10-2.08] for UC and 2.04 [1.11-3.77] for CD. When taking into account both the underlying and the immediate cause of death, infection was more frequent in patients with IBD. Conclusions Overall, all-cause mortality rates were similar between patients with IBD and controls. However, clinicians should remain alert to cardiovascular diseases and infections, particularly in specific subgroups of CD patients.

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High Rates of Mortality in Geriatric Patients Admitted for Inflammatory Bowel Disease Management

Cited by 9 publications

References 40 publications

Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach

Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach

Ulcerative Colitis in Adulthood and in Older Patients: Same Disease, Same Outcome, Same Risks?

Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study)

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