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Histologic Activity in Inflammatory Bowel Disease and Risk of Serious Infections : A Nationwide Study

Mårild, Karl ; Söderling, Jonas ; Axelrad, Jordan ; Halfvarson, Jonas ; Forss, Anders ; Olsson, Malin LU ; Olén, Ola and Ludvigsson, Jonas F. (2024) In Clinical Gastroenterology and Hepatology 22(4). p.831-846
Abstract

Background & Aims: Individuals with inflammatory bowel disease (IBD) are at increased risk of serious infections, but whether this risk varies by histologic disease activity is unclear. Methods: This was a national population-based study of 55,626 individuals diagnosed with IBD in 1990 to 2016 with longitudinal data on ileocolorectal biopsy specimens followed up through 2016. Serious infections were defined as having an inpatient infectious disease diagnosis in the Swedish National Patient Register. We used Cox regression to estimate hazard ratios (HRs) for serious infections in the 12 months after documentation of histologic inflammation (vs histologic remission), adjusting for social and demographic factors, chronic comorbidities,... (More)

Background & Aims: Individuals with inflammatory bowel disease (IBD) are at increased risk of serious infections, but whether this risk varies by histologic disease activity is unclear. Methods: This was a national population-based study of 55,626 individuals diagnosed with IBD in 1990 to 2016 with longitudinal data on ileocolorectal biopsy specimens followed up through 2016. Serious infections were defined as having an inpatient infectious disease diagnosis in the Swedish National Patient Register. We used Cox regression to estimate hazard ratios (HRs) for serious infections in the 12 months after documentation of histologic inflammation (vs histologic remission), adjusting for social and demographic factors, chronic comorbidities, prior IBD-related surgery, and hospitalization. We also adjusted for IBD-related medications in sensitivity analyses. Results: With histologic inflammation vs remission, there was 4.62 (95% CI, 4.46-4.78) and 2.53 (95% CI, 2.36–2.70) serious infections per 100 person-years of follow-up, respectively (adjusted HR [aHR], 1.59; 95% CI, 1.48–1.72). Histologic inflammation (vs remission) was associated with an increased risk of serious infections in ulcerative colitis (aHR, 1.68; 95% CI, 1.51–1.87) and Crohn's disease (aHR, 1.59; 95% CI, 1.40–1.80). The aHRs of sepsis and opportunistic infections were 1.66 (95% CI, 1.28–2.15) and 1.71 (95% CI, 1.22–2.41), respectively. Overall, results were consistent across age groups, sex, and education level, and remained largely unchanged after adjustment for IBD-related medications (aHR, 1.47; 95% CI, 1.34–1.61). Conclusions: Histologic inflammation of IBD was an independent risk factor of serious infections, including sepsis, suggesting that achieving histologic remission may reduce infections in IBD. The study was approved by the Stockholm Ethics Review Board (approval numbers 2014/1287-31/4, 2018/972-32, and 2021-06209-01).

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author
; ; ; ; ; ; and
contributor
LU ; LU and LU
author collaboration
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Histology, Infections, Population-Based
in
Clinical Gastroenterology and Hepatology
volume
22
issue
4
pages
831 - 846
publisher
Elsevier
external identifiers
  • pmid:37913937
  • scopus:85183531328
ISSN
1542-3565
DOI
10.1016/j.cgh.2023.10.013
language
English
LU publication?
no
additional info
Publisher Copyright: © 2024 The Author(s)
id
1d572737-92f7-4f5c-a164-1c746bc954a9
date added to LUP
2024-10-29 11:09:59
date last changed
2025-07-09 22:17:07
@article{1d572737-92f7-4f5c-a164-1c746bc954a9,
  abstract     = {{<p>Background &amp; Aims: Individuals with inflammatory bowel disease (IBD) are at increased risk of serious infections, but whether this risk varies by histologic disease activity is unclear. Methods: This was a national population-based study of 55,626 individuals diagnosed with IBD in 1990 to 2016 with longitudinal data on ileocolorectal biopsy specimens followed up through 2016. Serious infections were defined as having an inpatient infectious disease diagnosis in the Swedish National Patient Register. We used Cox regression to estimate hazard ratios (HRs) for serious infections in the 12 months after documentation of histologic inflammation (vs histologic remission), adjusting for social and demographic factors, chronic comorbidities, prior IBD-related surgery, and hospitalization. We also adjusted for IBD-related medications in sensitivity analyses. Results: With histologic inflammation vs remission, there was 4.62 (95% CI, 4.46-4.78) and 2.53 (95% CI, 2.36–2.70) serious infections per 100 person-years of follow-up, respectively (adjusted HR [aHR], 1.59; 95% CI, 1.48–1.72). Histologic inflammation (vs remission) was associated with an increased risk of serious infections in ulcerative colitis (aHR, 1.68; 95% CI, 1.51–1.87) and Crohn's disease (aHR, 1.59; 95% CI, 1.40–1.80). The aHRs of sepsis and opportunistic infections were 1.66 (95% CI, 1.28–2.15) and 1.71 (95% CI, 1.22–2.41), respectively. Overall, results were consistent across age groups, sex, and education level, and remained largely unchanged after adjustment for IBD-related medications (aHR, 1.47; 95% CI, 1.34–1.61). Conclusions: Histologic inflammation of IBD was an independent risk factor of serious infections, including sepsis, suggesting that achieving histologic remission may reduce infections in IBD. The study was approved by the Stockholm Ethics Review Board (approval numbers 2014/1287-31/4, 2018/972-32, and 2021-06209-01).</p>}},
  author       = {{Mårild, Karl and Söderling, Jonas and Axelrad, Jordan and Halfvarson, Jonas and Forss, Anders and Olsson, Malin and Olén, Ola and Ludvigsson, Jonas F.}},
  issn         = {{1542-3565}},
  keywords     = {{Histology; Infections; Population-Based}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{831--846}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Gastroenterology and Hepatology}},
  title        = {{Histologic Activity in Inflammatory Bowel Disease and Risk of Serious Infections : A Nationwide Study}},
  url          = {{http://dx.doi.org/10.1016/j.cgh.2023.10.013}},
  doi          = {{10.1016/j.cgh.2023.10.013}},
  volume       = {{22}},
  year         = {{2024}},
}