Histologic inflammation of IBD a risk factor for serious infections

Among individuals with inflammatory bowel disease (IBD), histologic inflammation appears to contribute to an increased risk of serious infections such as sepsis, according to a study, suggesting that achieving remission may reduce infections in IBD.

The study included 55,626 people with IBD who had available longitudinal data on ileo-colorectal biopsies throughout the follow-up period. Serious infections were determined using the Swedish National Patient Register.

Researchers applied Cox regression to examine the incidence of serious infections in the 12 months following documentation of histologic inflammation as opposed to histologic remission. Social and demographic factors, chronic comorbidities, prior IBD-related surgery, and hospitalization were included in the analysis as confounding factors.

The incidence rates of serious infections were 4.62 per 100 person-years (95 percent confidence interval [CI], 4.46–4.78) among participants with histologic inflammation and 2.53 per 100 person-years (95 percent CI, 2.36–2.70) among those with remission.

Histologic inflammation was associated with an increased risk of developing serious infections in the IBD population (adjusted hazard ratio [aHR], 1.59, 95 percent CI, 1.48–1.72), including those with ulcerative colitis (aHR, 1.68, 95 percent CI, 1.51–1.87) and Crohn’s disease (aHR, 1.59, 95 percent CI, 1.40–1.80).

The risk increase associated with histologic inflammation was seen for sepsis (aHR, 1.66, 95 percent CI, 1.28–2.15) and opportunistic infections (aHR, 1.71, 95 percent CI, 1.22–2.41).

The results were consistent across subgroups defined by age, sex, and education level, with no material change despite adjustment for IBD-related medications (aHR, 1.47, 95 percent CI, 1.34–1.61).

Histological inflammation of IBD was an independent risk factor of serious infections, including sepsis, suggesting that achieving histological remission may reduce infections in IBD.