Abhishek Verma1, Sanskriti Varma2, Daniel E Freedberg3, Jordan E Axelrad4. 1. Department of Medicine, NYU Langone Health, 550 First Avenue, NBV 16 North 30, New York, NY, 10016, USA. 2. Department of Medicine, New York Presbyterian Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA. 3. Division of Digestive and Liver Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, 3rd Floor, New York, NY, 10032, USA. 4. Division of Gastroenterology, NYU Langone Health, Inflammatory Bowel Disease Center at NYU Langone Health, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA. Jordan.Axelrad@nyulangone.org.
Abstract
BACKGROUND AND AIMS: Thirty percent of inflammatory bowel disease (IBD) patients hospitalized with flare require salvage therapy or surgery. Additionally, 40% experience length of stay (LOS) > 7 days. No emergency department (ED)-based indices exist to predict these adverse outcomes at admission for IBD flare. We examined whether clinical, laboratory, and endoscopic markers at presentation predicted prolonged LOS, inpatient colectomy, or salvage therapy in IBD patients admitted with flare. METHODS: Patients with ulcerative colitis (UC) or colonic involvement of Crohn's disease (CD) hospitalized with flare and tested for Clostridioides difficile infection (CDI) between 2010 and 2020 at two urban academic centers were studied. The primary outcome was complex hospitalization, defined as: LOS > 7 days, inpatient colectomy, or inpatient infliximab or cyclosporine. A nested k-fold cross-validation identified predictive factors of complex hospitalization. RESULTS: Of 164 IBD admissions, 34% (56) were complex. Predictive factors included: tachycardia in ED triage (odds ratio [OR] 3.35; confidence interval [CI] 1.79-4.91), hypotension in ED triage (3.45; 1.79-5.11), hypoalbuminemia at presentation (2.54; 1.15-3.93), CDI (2.62; 1.02-4.22), and endoscopic colitis (4.75; 1.75-5.15). An ED presentation score utilizing tachycardia and hypoalbuminemia predicted complex hospitalization (area under curve 0.744; CI 0.671-0.816). Forty-four of 48 (91.7%) patients with a presentation score of 0 (heart rate < 99 and albumin ≥ 3.4 g/dL) had noncomplex hospitalization. CONCLUSIONS: Over 90% of IBD patients hospitalized with flare with an ED presentation score of 0 did not require salvage therapy, inpatient colectomy, or experience prolonged LOS. A simple ED-based score may provide prognosis at a juncture of uncertainty in patient care.
BACKGROUND AND AIMS: Thirty percent of inflammatory bowel disease (IBD) patients hospitalized with flare require salvage therapy or surgery. Additionally, 40% experience length of stay (LOS) > 7 days. No emergency department (ED)-based indices exist to predict these adverse outcomes at admission for IBD flare. We examined whether clinical, laboratory, and endoscopic markers at presentation predicted prolonged LOS, inpatient colectomy, or salvage therapy in IBD patients admitted with flare. METHODS: Patients with ulcerative colitis (UC) or colonic involvement of Crohn's disease (CD) hospitalized with flare and tested for Clostridioides difficile infection (CDI) between 2010 and 2020 at two urban academic centers were studied. The primary outcome was complex hospitalization, defined as: LOS > 7 days, inpatient colectomy, or inpatient infliximab or cyclosporine. A nested k-fold cross-validation identified predictive factors of complex hospitalization. RESULTS: Of 164 IBD admissions, 34% (56) were complex. Predictive factors included: tachycardia in ED triage (odds ratio [OR] 3.35; confidence interval [CI] 1.79-4.91), hypotension in ED triage (3.45; 1.79-5.11), hypoalbuminemia at presentation (2.54; 1.15-3.93), CDI (2.62; 1.02-4.22), and endoscopic colitis (4.75; 1.75-5.15). An ED presentation score utilizing tachycardia and hypoalbuminemia predicted complex hospitalization (area under curve 0.744; CI 0.671-0.816). Forty-four of 48 (91.7%) patients with a presentation score of 0 (heart rate < 99 and albumin ≥ 3.4 g/dL) had noncomplex hospitalization. CONCLUSIONS: Over 90% of IBD patients hospitalized with flare with an ED presentation score of 0 did not require salvage therapy, inpatient colectomy, or experience prolonged LOS. A simple ED-based score may provide prognosis at a juncture of uncertainty in patient care.
Authors: Geoffrey C Nguyen; Anne Tuskey; Themistocles Dassopoulos; Mary L Harris; Steven R Brant Journal: Inflamm Bowel Dis Date: 2007-12 Impact factor: 5.325
Authors: Dan Turner; Catharine M Walsh; A Hillary Steinhart; Anne M Griffiths Journal: Clin Gastroenterol Hepatol Date: 2006-12-04 Impact factor: 11.382
Authors: G T Ho; C Mowat; C J R Goddard; J M Fennell; N B Shah; R J Prescott; J Satsangi Journal: Aliment Pharmacol Ther Date: 2004-05-15 Impact factor: 8.171
Authors: A Aratari; C Papi; V Clemente; A Moretti; R Luchetti; M Koch; L Capurso; R Caprilli Journal: Dig Liver Dis Date: 2008-05-09 Impact factor: 4.088
Authors: Mazen Issa; Aravind Vijayapal; Mary Beth Graham; Dawn B Beaulieu; Mary F Otterson; Sarah Lundeen; Susan Skaros; Lydia R Weber; Richard A Komorowski; Josh F Knox; Jeanne Emmons; Jasmohan S Bajaj; David G Binion Journal: Clin Gastroenterol Hepatol Date: 2007-03 Impact factor: 11.382
Authors: Teresa B Gibson; Eliza Ng; Ronald J Ozminkowski; Shaohung Wang; Wayne N Burton; Ron Z Goetzel; Ross Maclean Journal: J Occup Environ Med Date: 2008-11 Impact factor: 2.162