Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection - Scorecard - MDSpire
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Outcomes After Hospital Discharge in Older Adults with Inflammatory Bowel Disease Flare and Clostridioides difficile Infection Complications

  • By

  • Idan Goren

  • Ortal Fallek Boldes

  • Tomer Boldes

  • Oleg Knyazev

  • Anna Kagramanova

  • Jimmy K Limdi

  • Eleanor Liu

  • Karishma Sethi-Arora

  • Tom Holvoet

  • Piotr Eder

  • Cristina Bezzio

  • Simone Saibeni

  • Marta Vernero

  • Eleonora Alimenti

  • María Chaparro

  • Javier P Gisbert

  • Eleni Orfanoudaki

  • Ioannis E Koutroubakis

  • Daniela Pugliese

  • Giuseppe Cuccia

  • Cristina Calviño Suarez

  • Davide Giuseppe Ribaldone

  • Ido Veisman

  • Kassem Sharif

  • Stefano Festa

  • Annalisa Aratari

  • Claudio Papi

  • Iordanis Mylonas

  • Gerassimos J Mantzaris

  • Marie Truyens

  • Triana Lobaton Ortega

  • Stéphane Nancey

  • Fabiana Castiglione

  • Olga Maria Nardone

  • Giulio Calabrese

  • Konstantinos Karmiris

  • Magdalini Velegraki

  • Angeliki Theodoropoulou

  • Ariella Bar-Gil Shitrit

  • Milan Lukas

  • Gabriela Vojtechová

  • Pierre Ellul

  • Luke Bugeja

  • Edoardo V Savarino

  • Tali Sharar Fischler

  • Iris Dotan

  • Henit Yanai

  • October 21, 2024

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Clinical Scorecard: Outcomes After Hospital Discharge in Older Adults with Inflammatory Bowel Disease Flare and Clostridioides difficile Infection Complications

At a Glance

CategoryDetail
ConditionInflammatory Bowel Disease (IBD) flare with or without concurrent Clostridioides difficile infection (CDI) in elderly patients
Key MechanismsIBD flare potentially triggered or complicated by CDI; CDI known as an environmental trigger and risk factor for IBD exacerbation
Target PopulationElderly patients (≥60 years) hospitalized for IBD flare and tested for CDI
Care SettingHospital inpatient setting with post-discharge follow-up

Key Highlights

  • In elderly IBD patients hospitalized for flare, concurrent CDI was not associated with increased post-discharge complications or mortality up to 1 year.
  • Charlson comorbidity index was the only significant risk factor for 3-month post-discharge complications; mesalamine (5-ASA) use was protective.
  • Ulcerative colitis diagnosis was a risk factor for complications at 6 months post-discharge.

Guideline-Based Recommendations

Diagnosis

  • Test all elderly patients hospitalized for IBD flare for CDI within 72 hours of admission using institutional standard assays.

Management

  • Continue or optimize mesalamine (5-ASA) therapy as it may be protective against post-discharge complications.
  • Monitor and manage comorbidities as indicated by Charlson comorbidity index to reduce risk of complications.

Monitoring & Follow-up

  • Assess for steroid dependency, IBD-related re-admissions, surgery, and mortality at 3 and 6 months post-discharge.
  • Monitor mortality outcomes up to 12 months post-discharge.

Risks

  • Higher Charlson comorbidity index scores increase risk of post-discharge complications.
  • Ulcerative colitis diagnosis increases risk of complications at 6 months.
  • Concurrent CDI does not significantly increase risk of post-discharge complications or mortality.

Patient & Prescribing Data

Elderly patients (≥60 years) hospitalized for IBD flare with or without CDI

Mesalamine (5-ASA) use is associated with reduced risk of 3-month post-discharge complications; immunosuppressive agents and antibiotic exposure are known CDI risk factors but not directly linked to post-discharge outcomes in this study.

Clinical Best Practices

  • Screen elderly IBD patients hospitalized for flare for CDI promptly to guide management.
  • Use Charlson comorbidity index to stratify risk and tailor post-discharge care.
  • Maintain or initiate mesalamine therapy when appropriate to reduce complication risk.
  • Recognize ulcerative colitis patients as higher risk for intermediate-term complications and monitor accordingly.
  • Provide comprehensive follow-up for at least 12 months post-discharge to monitor complications and mortality.

References

Original Source(s)

Post-Discharge Outcomes of Elderly Patients Hospitalized for Inflammatory Bowel Disease Flare Complicated by Clostridioides difficile Infection

  • by Idan Goren, Ortal Fallek Boldes, Tomer Boldes, Oleg Knyazev, Anna Kagramanova, Jimmy K Limdi, Eleanor Liu, Karishma Sethi-Arora, Tom Holvoet, Piotr Eder, Cristina Bezzio, Simone Saibeni, Marta Vernero, Eleonora Alimenti, María Chaparro, Javier P Gisbert, Eleni Orfanoudaki, Ioannis E Koutroubakis, Daniela Pugliese, Giuseppe Cuccia, Cristina Calviño Suarez, Davide Giuseppe Ribaldone, Ido Veisman, Kassem Sharif, Stefano Festa, Annalisa Aratari, Claudio Papi, Iordanis Mylonas, Gerassimos J Mantzaris, Marie Truyens, Triana Lobaton Ortega, Stéphane Nancey, Fabiana Castiglione, Olga Maria Nardone, Giulio Calabrese, Konstantinos Karmiris, Magdalini Velegraki, Angeliki Theodoropoulou, Ariella Bar-Gil Shitrit, Milan Lukas, Gabriela Vojtechová, Pierre Ellul, Luke Bugeja, Edoardo V Savarino, Tali Sharar Fischler, Iris Dotan, Henit Yanai

  • October 21, 2024

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