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Oral Corticosteroids and the Risk of Serious Infections in Patients With Elderly-Onset Inflammatory Bowel Diseases
被引:93
作者:

Brassard, Paul
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McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada

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Suissa, Alain
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Technion Israel Inst Technol, Dept Gastroenterol, Haifa, Israel McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada

Sinyavskaya, Liliya
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McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada

Patenaude, Valerie
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McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada

Suissa, Samy
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McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada
机构:
[1] McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada
[2] McGill Univ, Dept Med, Div Gastroenterol, Ctr Hlth, Montreal, PQ H3T 1E2, Canada
[3] Technion Israel Inst Technol, Dept Gastroenterol, Haifa, Israel
关键词:
INHALED CORTICOSTEROIDS;
MEDICAL-MANAGEMENT;
ISOTRETINOIN;
VALIDATION;
PNEUMONIA;
DIAGNOSES;
MORTALITY;
ACCURACY;
DATABASE;
THERAPY;
D O I:
10.1038/ajg.2014.313
中图分类号:
R57 [消化系及腹部疾病];
学科分类号:
摘要:
OBJECTIVES: Systemic corticosteroids are among the most common anti-inflammatory treatments in elderly-onset inflammatory bowel disease (IBD) patients. Steroid use and older age each independently predisposes to infections, and infections increase mortality in hospitalized older IBD patients. Therefore, our objective was to examine the risk of serious infections in elderly-onset IBD patients treated with oral corticosteroids, and explore how the timing of exposure affects the risk estimates. METHODS: Using the health-care databases of the province of Quebec, Canada, we conducted a population-based cohort study with a nested case-control analysis. Incident IBD patients aged >= 66 years were identified. Conditional logistic regression was performed to estimate crude and adjusted rate ratios (aRRs) with 95% confidence intervals (CIs). RESULTS: We identified 3,522 elderly-onset patients, of which 564 cases with serious infections were identified during a mean 4.4 years of follow-up (incidence rate 3.7 per 100 per year) and matched to 2,646 controls. The rate of serious infections was significantly higher in those exposed to oral corticosteroids any time during the previous 6-month period compared with those nonexposed (aRR 2.3; 95% CI 1.8-2.9). Those currently exposed (within 45 days) had a higher risk (aRR 2.8; 95% CI 2.1-3.7). The residual effect of oral corticosteroids remained marginally statistically significant up to the 90-day period before the index date (aRR 1.7; 95% CI 1.0-2.7). CONCLUSIONS: We found an excess relative risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy. Those with current exposure demonstrated a higher vulnerability to infections.
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页码:1795 / 1802
页数:8
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h-index: 0
机构:
Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Abrahamowicz, Michal
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机构:
McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Beauchamp, Marie-Eve
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机构: Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Ray, David W.
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机构:
Univ Manchester, Manchester Acad Hlth Sci Ctr, Endocrine Sci Res Grp, Manchester M13 9PT, Lancs, England Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Bernatsky, Sasha
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机构:
McGill Univ, Dept Med, Div Clin Epidemiol, Ctr Hlth, Montreal, PQ, Canada
McGill Univ, Dept Med, Div Rheumatol, Ctr Hlth, Montreal, PQ, Canada Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Suissa, Samy
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McGill Univ, Jewish Gen Hosp, Lady Davis Inst, Ctr Clin Epidemiol, Montreal, PQ H3T 1E2, Canada Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England

Sylvestre, Marie-Pierre
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机构:
Univ Montreal, Ctr Hosp, Res Ctr, Montreal, PQ, Canada
Univ Montreal, Dept Social & Prevent Med, Montreal, PQ, Canada Univ Manchester, Manchester Acad Hlth Sci Ctr, Arthrit Res UK Epidemiol Unit, Manchester M13 9PT, Lancs, England