Clinical Science
Long-term risk of mesenteric ischemia in patients with inflammatory bowel disease: a 13-year nationwide cohort study in an Asian population

https://doi.org/10.1016/j.amjsurg.2014.08.026Get rights and content

Highlights

  • Patients with IBD had a considerably higher incidence rate of subsequent MI.

  • After adjustment for comorbidities, MI is particularly higher in patients younger than 44 years.

  • IBD was at highest risk of developing MI within the first year of follow-up.

Abstract

Background

It is unclear whether patients with inflammatory bowel disease (IBD) have higher risks of developing mesenteric ischemia.

Methods

We enrolled 9,363 patients who had been hospitalized because of IBD between January 1998 and December 2010, along with 37,452 control patients who were matched at a 1:4 proportion for age, sex, and index year. We accounted the cumulative incidences and hazard ratios (HRs) of developing mesenteric ischemia during the 13-year study period.

Results

Patients with IBD had a considerably higher incidence rate of subsequent mesenteric ischemia compared with the controls (22.7 vs 3.09 per 10,000 person-years), with adjusted HR of 6.33 (95% confidence interval: 4.75 to 8.43). A multivariate stratified analysis showed that the mesenteric ischemia risk after adjustment for comorbidities is significantly higher in patients of all age groups, particularly in patients younger than 44 years (adjusted HR: 48.0; 95% confidence interval: 11.3 to 203.9). Moreover, patients with IBD were at highest risk of developing mesenteric ischemia within the first year of follow-up.

Conclusions

Careful follow-up and effective therapy are necessary to reduce the excessive risk in these patients.

Section snippets

Data source

The nationwide cohort study was based on data obtained from the NHIRD and the Bureau of National Health Insurance. The NHIRD contains healthcare data of nearly 99% of the entire Taiwanese population (23 million) and is contracted with 97% of clinics and hospitals throughout the nation (http://nhird.nhri.org.tw/en/index.htm). We obtained longitudinal person-level data on medical care by linking an encrypted unique personal identification from 2 files: registry for beneficiaries and inpatient

Results

We identified 46,815 patients who were eligible for this study, with 9,363 patients in the IBD cohort and 37,452 patients in the non-IBD cohort. The mean follow-up periods were 6.44 ± 3.75 years in the IBD cohort and 7.18 ± 3.39 in the non-IBD cohort. The demographic characteristics are shown in Table 1. The mean ages for the IBD and non-IBD cohorts were 53.1 (standard deviation = 18.9) and 52.7 (standard deviation = 18.9) years (P = .04), respectively. More male patients were involved in this

Comments

This is the first study to address the long-term risk of mesenteric ischemia in patients with IBD based on nationwide data. This population-based cohort study shows that the long-term risk of mesenteric ischemia is significantly higher in patients with IBD, with an AHR of 6.43 (95% CI: 4.83 to 8.56) for mesenteric ischemia within 13 years, after accounting for mortality as the competing cause of risk and adjusting for multiple known confounding factors for mesenteric ischemia. Moreover, the HR

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    Supported in part by the study projects of DMR-103-018 of China Medical University Hospital; Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW103-TDU-B-212-113002), Health and welfare surcharge of tobacco products, China Medical University Hospital Cancer Research Center of Excellence (MOHW103-TD-B-111-03, Taiwan); and International Research-Intensive Centers of Excellence in Taiwan (I-RiCE) (NSC101-2911-I-002-303). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

    The authors declare no conflicts of interest.

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