P1625 - Early Corticosteroid Treatment for Patients Requiring Hospitalization for Acute IBD Exacerbations Prior to Testing for C. difficile Likely Safe

Jaya Vasudevan, MD¹, Bani Dhother, ², Paul Guzik, DO¹, Benjamin Chebaa, BA¹, Linda A. Feagins, MD^1
1University of Texas at Austin Dell Medical School, Austin, TX; ²University of Texas, Austin, TX

Introduction: Patients hospitalized with a suspected exacerbation of inflammatory bowel disease (IBD) are often treated with corticosteroids prior to completing infectious work-up to assess for C. difficile infection. However, it is unclear if early treatment (i.e. before C. difficile testing) increases the likelihood of poor outcomes or if this is a safe approach to improve patient symptoms as early as possible even if C. difficile is found.

Methods: Retrospective review of IBD-related hospitalizations from 7 area hospitals between 2015 to 2020. Using administrative data, relevant adult patient encounters were identified by ICD-9 or 10 code of 556.x, 555.x. K51.x, or K50.x. Charts were reviewed and included if admitted for an IBD flare and received treatment with corticosteroids. Patients with new IBD diagnoses were excluded. Primary outcomes were length of stay (LOS), ICU stay during admission, and mortality.

Results: 559 inpatient encounters for IBD flares were identified who received treatment with corticosteroids. Of these, 378 (68%) were tested for C. difficile. Of those, 255 (67%) received steroids prior to testing while the rest started steroids after C. difficile had been completed. Rates of C. difficile infection were similar in both groups (3.9% vs 4.1%, p=.95). There were no differences between groups treated before or after C. difficile testing in regards to age, race, sex, ethnicity, payor, Charlson Comorbidity Index, fever, leukocytosis, creatinine, and C-reactive protein. Albumin was lower in patients who received corticosteroids later (see table). LOS was not shorter for those who started steroids early and, to the contrary, was slightly longer (5.5 days vs 5.2 days, p=.02). Rates of being treated in the ICU (.8% vs .8%, p=.98, steroids prior vs steroids after) and inpatient mortality (.3% vs 0%, p=.49) were not significantly different between the groups. Specifically, for patients who were positive for C. difficile, none were admitted to the ICU and none died in either group.

Discussion: We found that for inpatients with suspected IBD flares, early treatment (i.e. prior to C. difficile testing) did not increase the risk for ICU admissions or death during that hospital stay. However, this practice also did not shorten LOS for these inpatient encounters. This data suggests that early initiation of corticosteroids for suspected flares while awaiting results for C. difficile is unlikely to be detrimental. However, further data is needed to understand if this practice is truly beneficial.

	Steroids PRIOR n=255	Steroids AFTER n=123	p-value
Age	36.8	38.3	.55
Sex (%male)	122 (48%)	51 (41%)	.29
Race
White	208	97	.63
Black	28	15	.86
Asian	7	0	.15
Other / unknown	12	11	.17
Ethnicity
Hispanic	31	21	.25
Non-Hispanic	180	86	.99
Unknown	44	16	.36
Insurance
Uninsured	37	20	.77
County Assistance	23	14	.59
Medicaid	28	14	.91
Medicare	28	13	.90
Commercial	135	61	.62
VA	4	0	.39
Jail	0	1	.71
CCI score (± SEM)	0.19 ± 0.03	0.26 ± 0.07	.88
Type of IBD
Crohn’s disease	159 (62%)	48 (39%)	< 0.0001
ileal	67	6	.00003
ileocolonic	53	23	.0957
colonic	38	19	.0515
unknown	1	0
Ulcerative colitis	93 (36%)	74 (60%)	< 0.0001
proctitis	1	1	.87
Left sided	35	31	.69
extensive	53	42	.98
Unknown	4	0	.58
IBDU	3 (1.2%)	1 (0.8%)
Crohns behavior
Inflammatory	41	24	.003
Stricturing	63	10	.0267
penetrating	54	14	.66
Unknown	1	0	.58
UGI Crohns	6	4	.36
Perianal disease	41 (16%)	12 (10%)	.91
Presentation symptoms
Fever	4 (1.6%)	3 (2.4%)	.86
Tachycardia	45 (17.6%)	36 (29.3%)	.0144
Labs at presentation
Albumin	3.4 ± .05	3.1 ± .07	.002
CRP (normal < 0.5)	7.0 ± .76	8.9 ± 1.24	.24
White blood cell count	11.8 ± .34	11.5 ± .47	.41
Creatinine	0.89 ± .02	0.88 ± .03	.59

Table: Table 1: Comparison of groups who were treated early (prior to C. difficile testing) and those treated after C. difficile testing who were admitted as inpatients with suspected acute exacerbations of their IBD.


Disclosures:
Jaya Vasudevan indicated no relevant financial relationships.
Bani Dhother indicated no relevant financial relationships.
Paul Guzik indicated no relevant financial relationships.
Benjamin Chebaa indicated no relevant financial relationships.
Linda Feagins: Arena Pharmaceuticals – Grant/Research Support. Corrona LLC – Grant/Research Support.


Jaya Vasudevan, MD¹, Bani Dhother, ², Paul Guzik, DO¹, Benjamin Chebaa, BA¹, Linda A. Feagins, MD¹. P1625 - Early Corticosteroid Treatment for Patients Requiring Hospitalization for Acute IBD Exacerbations Prior to Testing for C. difficile Likely Safe, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.