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Clinical assessment of risk factors for infection in inflammatory bowel disease patients

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Abstract

Purpose

Recognizing patients with inflammatory bowel disease who are prone to infection would enable the adjustment of the type and intensity of immunosuppressive treatment. The aim of this study was to identify a clinical profile of risk for infections in IBD patients, based on the interaction of immunosuppressive treatment with factors inherent to the patient.

Methods

A case-control study was performed among patients older than 18 years. Patients with any significant infection (any kind of severe or recurrent infection according to standard clinical criteria or a critical enough infection according to the patient) were defined as cases. Both cases and controls were randomly selected in a 1:3 ratio. All the period from diagnosis to the end of recruitment (June 2016) was analyzed. Risk factors for infection were identified by logistic regression analysis; the strength of association was reported by odds ratio (OR) with 95% confidence interval (95%CI).

Results

A total of 112 cases and 270 controls were included. The independent risk factors for significant infection are the number of immunosuppressants (one drug: OR 1.28, 95% CI 0.53–3.11, two drugs: OR 2.37, 95% CI 1.01–5,56, and three drugs: OR 5.84, 95% CI 1.57–21.72), body mass index (OR 1.08; 95 %CI 1,01–1,16), the degree of comorbidity (OR 1.52; 95% CI 1.04–2.21), and the intensity of inflammatory activity (OR 1.43; 95% CI 1.19–1.71).

Conclusions

Regardless of immunosuppression, several patient factors such as comorbidity, body mass index, or the inflammatory activity of the disease determine the individual risk of infectious complications and should be considered for an adequate risk assessment.

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Acknowledgments

We would like to acknowledge Professor Frances Watts, Applied Linguistics, Polytechnic University of Valencia, for her language review.

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Author notes

  1. Joan Tosca and Natalia Garcia contributed equally to this paper and share co-first authorship.

Authors and Affiliations

  1. Digestive Medicine department, Hospital Clínic Universitari de Valencia, Universitat de Valencia, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain

    Joan Tosca, Isabel Pascual, Marta Maia Bosca-Watts, Rosario Anton, Ana Sanahuja, Pilar Mas, Francisco Mora & Miguel Minguez

  2. Digestive Medicine department, Hospital de Manises, Avda. de la Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain

    Natalia Garcia

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  1. Joan Tosca
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Tosca, J., Garcia, N., Pascual, I. et al. Clinical assessment of risk factors for infection in inflammatory bowel disease patients. Int J Colorectal Dis 35, 491–500 (2020). https://doi.org/10.1007/s00384-019-03501-0

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