Predictors of ICU Admission and Outcomes 1 Year Post-Admission in Persons with IBD: A Population-based Study

BACKGROUND To determine predictors of intensive care unit (ICU) admission and to assess health care utilization (HCU) post-ICU admission among persons with inflammatory bowel disease (IBD). METHODS We matched a population-based database of Manitobans with IBD to a general population cohort on age, sex, and region of residence and linked these cohorts to a population-based ICU database. We compared the incidence rates of ICU admission among prevalent IBD cases according to HCU in the year before admission using generalized linear models adjusting for age, sex, socioeconomic status, region, and comorbidity. Among incident cases of IBD who survived their first ICU admission, we compared HCU with matched controls who survived ICU admission. RESULTS Risk factors for ICU admission from the year before admission included cumulative corticosteroid use (incidence rate ratio, 1.006 per 100 mg of prednisone; 95% confidence interval, 1.004-1.008) and IBD-related surgery (incidence rate ratio, 2.79; 95% confidence interval, 1.99-3.92). Use of immunomodulatory therapies within 1 year, or surgery for IBD beyond 1 year prior, were not associated with ICU admission. In those who used corticosteroids and immunomodulatory medications in the year before ICU admission, the use of immunomodulatory medications conferred a 30% risk reduction in ICU admission (incidence rate ratio, 0.70; 95% confidence interval, 0.50-0.97). Persons with IBD who survived ICU admission had higher HCU in the year following ICU discharge than controls. CONCLUSIONS Corticosteroid use and surgery within the year are associated with ICU admission in IBD while immunomodulatory therapy is not. Surviving ICU admission is associated with high HCU in the year post-ICU discharge.