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Increased Risk of Pneumonia Among Patients With Inflammatory Bowel Disease.
MedLine Citation:
PMID:  23295276     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:Patients with inflammatory bowel disease (IBD) may be at increased risk for infections. We aimed to determine the pneumonia risk in IBD and how specific medications affect this risk.METHODS:We performed a retrospective cohort and a nested case-control study using administrative data from IMS Health Inc., LifeLink Health Plan Claims Database. Limitations to this data set include lack of clinical details to validate exposures and outcomes. In the cohort, IBD patients were matched to four individuals without IBD. Pneumonia risk was evaluated by incidence rate ratio (IRR) and adjusted Cox proportional hazards models (hazard ratio (HR)). In the nested case-control, 4,856 IBD patients with pneumonia were matched to four IBD patients without pneumonia by incidence density sampling. We used conditional logistic regression to determine the associations between medications and pneumonia.RESULTS:The cohort included 50,932 patients with Crohn's disease (CD), 56,403 patients with ulcerative colitis (UC), and 1,269 with unspecified IBD; matched to 434,416 individuals without IBD. Median follow-up within the cohort was 24 months. The IBD cohort had an increased pneumonia risk when compared with non-IBD (IRR 1.82, 95% confidence interval (CI) 1.75-1.88). In adjusted Cox analysis, pneumonia risk remained increased for the IBD vs. non-IBD cohort (HR 1.54, 95% CI 1.49-1.60), with increased risk in both CD (HR 1.71, 95% CI 1.62-1.80) and UC (HR 1.41, 95% CI 1.34-1.48). In the nested case-control analysis, use of biologic medications (odds ratio (OR) 1.32, 95% CI 1.11-1.57), corticosteroids (OR 1.91, 95% CI 1.72-2.12), thiopurines (OR 1.13, 95% CI 1.00-1.27), proton-pump inhibitors (PPIs) (OR 1.15, 95% CI 1.04-1.26), or narcotics (2.28, 95% CI 2.09-2.48) was independently associated with pneumonia.CONCLUSIONS:Patients with IBD are at increased risk for pneumonia. Medications such as corticosteroids and narcotics are particularly associated with pneumonia in this population. An emphasis upon primary prevention of pneumonia through vaccination and reduction of risk factors is warranted.Am J Gastroenterol advance online publication, 8 January 2013; doi:10.1038/ajg.2012.406.
Authors:
Millie D Long; Christopher Martin; Robert S Sandler; Michael D Kappelman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-08
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  -     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1] Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [2] Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina, USA.
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