Histologic Activity in IBD Ups Risk of Serious Infections

TOPLINE:

Histologic inflammation in patients with inflammatory bowel disease (IBD) raises the risk of serious infection, even during periods of apparent low disease activity, highlighting the importance of achieving histologic remission with a fully healed intestinal mucosa, researchers say.

METHODOLOGY:

National population-based study of 55,626 adults diagnosed with IBD in 1990-2016 with longitudinal data on ileo-colorectal biopsies followed through 2016. About two thirds had ulcerative colitis and one third had Crohn's disease.
Cox regression was used to estimate hazard ratios (HRs) for serious infections requiring hospitalization in the 12 months following documentation of histologic inflammation (vs histologic remission).
Analyses were adjusted for social and demographic factors, chronic comorbidities, prior IBD-related surgery and hospitalization, and IBD-related medications.

TAKEAWAY:

With histologic inflammation, there were 4.62 serious infections per 100 person-years of follow-up versus 2.53 per 100 person-years of follow-up with histologic remission (adjusted HR, 1.59; 95% CI, 1.48 - 1.72).
Histologic inflammation was associated with an increased risk of serious infections in both ulcerative colitis (aHR, 1.68; 95% CI, 1.51 - 1.87) and Crohn's disease (aHR, 1.59; 95% CI, 1.40 - 1.80) compared with histologic remission.
Histologic inflammation was associated with an increased risk for sepsis (aHR, 1.66; 95% CI, 1.28 - 2.15) and opportunistic infections (aHR, 1.71; 95% CI, 1.22 - 2.41).
Results were consistent by age, sex, and education level, and remained largely unchanged after adjustment for IBD-related medications (aHR, 1.47; 95% CI, 1.34 - 1.61).
In a sensitivity analysis, histologic inflammation was associated with an increased risk of infections for patients who appeared to have clinically low IBD disease activity (aHR, 1.33; 95% CI, 1.13 - 1.57).

IN PRACTICE:

"In this nationwide study, histological inflammation of IBD was associated with an increased risk of serious infections overall and across infectious disease categories, including sepsis. Our findings suggest that achieving histological remission may reduce the risk of serious infections," the authors write.

SOURCE:

The study, with first author Karl Mårild, MD, PhD, Sahlgrenska Academy, University of Gothenburg, Sweden, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Clinical indications that may have prompted histologic examination were unknown. Histologic assessments may not capture the full burden of IBD activity. Researchers lacked data on whether histologic appearance changed in the 12 months since last biopsy. The study focused on serious infections and the findings may not relate to milder infections.

DISCLOSURES:

The study was funded by grants and had no commercial funding. Mårild is an investigator for a clinical trial funded by Pfizer. Other authors disclosed financial relationships with pharmaceutical, diagnostic, and medical device companies.

Credit:
Lead image: Dreamstime

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Cite this: Megan Brooks. Histologic Activity in IBD Ups Risk of Serious Infections - Medscape - Nov 27, 2023.

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