Comorbid Depression and IBD Significantly Increases Risk of Hospital Readmission, Mortality, According to National Database Review

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Individuals with comorbid depression and either ulcerative colitis (UC) or Crohn disease (CD) were found at significantly increased risk of hospital readmission and a “notably amplified” risk of mortality at 30 days post-readmission that increased substantially at 90 days, according to a new study presented at the 2024 Crohn’s & Colitis Congress, January 25-27, 2024, in Las Vegas, NV.

When correlated with a diagnosis of UC or CD, the leading etiologies associated with readmission were sepsis, hypertensive heart disease and sequelae, complications of renal disease, hypoxia, and acute depressive episodes (see below), according to the study abstract.

Presenting author Neethi R Dasu, DO, of Beth Israel Lahey Health, Burlington, MA, and fellow researchers refer to studies of causality that suggest individuals with either manifestation of inflammatory bowel disease (IBD) are vulnerable to experiencing mental health conditions that predate the gastrointestinal disorder and conversely, a preexisting mental health disorder such as depression may impact the disease process and course of IBD. They describe the “complexity of the interaction between depression and IBD” as “fertile ground” for investigations and point to the dearth of comprehensive study “examining the downstream effects of depression on patients with IBD.” Findings from their retrospective observational study will contribute to this field of inquiry.

Dasu and colleagues drew on National Readmissions Database data from 2016 to 2019, using ICD-10 codes to identify individuals with CD, UC, and depression. They defined primary outcomes as mortality and 30- and 90-day readmission rates. Secondary outcomes comprised index admission mortality, hospital length of stay (LOS), and total hospitalization charges (TOTHC) at 30 and 90 days. The team also identified the top 10 readmission diagnoses in each subgroup.

FINDINGS

Participants with CD and depression had a mean age of 51.6 years at hospital readmission. At 30 days rates for both readmission (5.2%,P < .01) and mortality (2.8%, P < .01) were high and increased significantly at 90 days (8.4%, P < .01 and 2.5%, P < .01, respectively ), according to the study. Dasu et al found that hospital LOS and TOTHC were relatively the same when compared to index admission for both 30- and 90-day readmissions (P < .01 for all).

The trend was quite similar for participants with UC and depression. Mean age at readmission was essentially the same, 51.4 years. Moreover, rates of readmission (5.0%, P < .01) and mortality (2.6%, P < .01) were equally as high, with a correspondingly significant rise in both at 90 days (8.1%, P < .01 and 2.9%, P < .01, respectively). As in the case of individuals with CD and depression, researchers reported hospital LOS and TOTHC comparable compared to index admission for 30- and 90-day readmissions (P < .01 for all).

The findings, Dasu et al wrote in conclusion to the abstract, underscore how important it is that health care providers screen routinely for depression and address management of mental health, “acknowledging the considerable impact it has on patients with co-occurring chronic diseases like UC or CD as an integral facet of comprehensive care.”

Source: John J, Dasu K, Kapoor A, et al. Hospital readmissions and mortality rates in patients with concurrent depression and inflammatory bowel disease: insights from the national readmissions database. Abstract presented at: 2024 Crohn’s & Colitis Congress; January 25-27, 2024; Las Vegas, NV. Accessed January 26, 2024.