Death from Crohn's disease. Lessons from a personal experience.
We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term "virulent" Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25-46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.
Mendelsohn
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RR
Department of Medicine, Lenox Hill Hospital, New York, NY 10021.
Korelitz
B I
BI
Gleim
G W
GW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002648:Child; D003424:Crohn Disease / Q000401:mortality* / Q000628:therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology