Joan Tosca1, Natalia Garcia2, Isabel Pascual3, Marta Maia Bosca-Watts3, Rosario Anton3, Ana Sanahuja3, Pilar Mas3, Francisco Mora3, Miguel Minguez3. 1. Digestive Medicine department, Hospital Clínic Universitari de Valencia, Universitat de Valencia, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain. joantosca@gmail.com. 2. Digestive Medicine department, Hospital de Manises, Avda. de la Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain. 3. Digestive Medicine department, Hospital Clínic Universitari de Valencia, Universitat de Valencia, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain.
Abstract
PURPOSE: Recognizing patients with inflammatory bowel disease who are prone to infection would enable the adjustment of the type and intensity of immunosuppressive treatment. The aim of this study was to identify a clinical profile of risk for infections in IBD patients, based on the interaction of immunosuppressive treatment with factors inherent to the patient. METHODS: A case-control study was performed among patients older than 18 years. Patients with any significant infection (any kind of severe or recurrent infection according to standard clinical criteria or a critical enough infection according to the patient) were defined as cases. Both cases and controls were randomly selected in a 1:3 ratio. All the period from diagnosis to the end of recruitment (June 2016) was analyzed. Risk factors for infection were identified by logistic regression analysis; the strength of association was reported by odds ratio (OR) with 95% confidence interval (95%CI). RESULTS: A total of 112 cases and 270 controls were included. The independent risk factors for significant infection are the number of immunosuppressants (one drug: OR 1.28, 95% CI 0.53-3.11, two drugs: OR 2.37, 95% CI 1.01-5,56, and three drugs: OR 5.84, 95% CI 1.57-21.72), body mass index (OR 1.08; 95 %CI 1,01-1,16), the degree of comorbidity (OR 1.52; 95% CI 1.04-2.21), and the intensity of inflammatory activity (OR 1.43; 95% CI 1.19-1.71). CONCLUSIONS: Regardless of immunosuppression, several patient factors such as comorbidity, body mass index, or the inflammatory activity of the disease determine the individual risk of infectious complications and should be considered for an adequate risk assessment.
PURPOSE: Recognizing patients with inflammatory bowel disease who are prone to infection would enable the adjustment of the type and intensity of immunosuppressive treatment. The aim of this study was to identify a clinical profile of risk for infections in IBDpatients, based on the interaction of immunosuppressive treatment with factors inherent to the patient. METHODS: A case-control study was performed among patients older than 18 years. Patients with any significant infection (any kind of severe or recurrent infection according to standard clinical criteria or a critical enough infection according to the patient) were defined as cases. Both cases and controls were randomly selected in a 1:3 ratio. All the period from diagnosis to the end of recruitment (June 2016) was analyzed. Risk factors for infection were identified by logistic regression analysis; the strength of association was reported by odds ratio (OR) with 95% confidence interval (95%CI). RESULTS: A total of 112 cases and 270 controls were included. The independent risk factors for significant infection are the number of immunosuppressants (one drug: OR 1.28, 95% CI 0.53-3.11, two drugs: OR 2.37, 95% CI 1.01-5,56, and three drugs: OR 5.84, 95% CI 1.57-21.72), body mass index (OR 1.08; 95 %CI 1,01-1,16), the degree of comorbidity (OR 1.52; 95% CI 1.04-2.21), and the intensity of inflammatory activity (OR 1.43; 95% CI 1.19-1.71). CONCLUSIONS: Regardless of immunosuppression, several patient factors such as comorbidity, body mass index, or the inflammatory activity of the disease determine the individual risk of infectious complications and should be considered for an adequate risk assessment.
Authors: J F Rahier; F Magro; C Abreu; A Armuzzi; S Ben-Horin; Y Chowers; M Cottone; L de Ridder; G Doherty; R Ehehalt; M Esteve; K Katsanos; C W Lees; E Macmahon; T Moreels; W Reinisch; H Tilg; L Tremblay; G Veereman-Wauters; N Viget; Y Yazdanpanah; R Eliakim; J F Colombel Journal: J Crohns Colitis Date: 2014-03-06 Impact factor: 9.071
Authors: J Keane; S Gershon; R P Wise; E Mirabile-Levens; J Kasznica; W D Schwieterman; J N Siegel; M M Braun Journal: N Engl J Med Date: 2001-10-11 Impact factor: 91.245
Authors: Gary R Lichtenstein; Brian G Feagan; Russell D Cohen; Bruce A Salzberg; Robert H Diamond; Donny M Chen; Michelle L Pritchard; William J Sandborn Journal: Clin Gastroenterol Hepatol Date: 2006-05 Impact factor: 11.382
Authors: Mark T Osterman; William J Sandborn; Jean-Frederic Colombel; Laurent Peyrin-Biroulet; Anne M Robinson; Qian Zhou; James D Lewis Journal: Am J Gastroenterol Date: 2016-09-27 Impact factor: 10.864
Authors: Gary R Lichtenstein; Brian G Feagan; Russell D Cohen; Bruce A Salzberg; Robert H Diamond; Samiyeh Price; Wayne Langholff; Anil Londhe; William J Sandborn Journal: Am J Gastroenterol Date: 2012-08-14 Impact factor: 10.864
Authors: Aysha H Al-Ani; Ralley E Prentice; Clarissa A Rentsch; Doug Johnson; Zaid Ardalan; Neel Heerasing; Mayur Garg; Sian Campbell; Joe Sasadeusz; Finlay A Macrae; Siew C Ng; David T Rubin; Britt Christensen Journal: Aliment Pharmacol Ther Date: 2020-05-26 Impact factor: 9.524