Corticosteroid-associated complications in elderly Crohn's disease patients.
OBJECTIVE
Although complications occur with long-term steroid usage in elderly Crohn's disease patients, there is little information on their short-term risk. This study was designed to assess that risk.


METHODS
We reviewed admissions from 1984 to 1995 and found 115 patients over age 50 yr with a confirmed flare of Crohn's disease. Of this group, 55 patients were treated with steroids. We studied potential complications including hypertension (blood pressure > or = 160/90), hyperglycemia (glucose > 200 mg/dl), hypokalemia (K < 3.5 meq/l), mental status changes, nosocomial infections, and heart failure.


RESULTS
The mean age was 67 yr (50-90), and 64% were women. There were no differences in baseline characteristics between patients treated with steroids and those not treated with steroids. The relative risk for developing complications are as follows: hypertension 1.46 (95% confidence interval (CI) = 1.09-1.95), hyperglycemia, 1.53 (95% CI = 0.54-4.32), hypokalemia, 1.59 (95% CI = 1.06-2.37), mental status changes, 7.64 (95% CI = 0.97-60.1), nosocomial infection, 1.09 (95% CI = 0.37-3.18), and congestive heart failure, 1.09 (95% CI = 0.16-7.48). Multivariate analyses adjusting for age, severity index, and number of comorbid conditions demonstrated similar findings to the unadjusted analyses. Analyses stratified by patient age demonstrated a similar risk of steroid associated complications for patients < 65 and > or = 65 yr of age.


CONCLUSIONS
Crohn's disease patients over age 50 yr treated with steroids are at significantly increased risk for developing hypertension and hypokalemia and at increased risk for developing mental status changes, but such steroid-effects were not more pronounced with advancing age.
Akerkar
G A
GA
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Peppercorn
M A
MA
Hamel
M B
MB
Parker
R A
RA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D002303:Cardiac Output, Low / Q000139:chemically induced; D015897:Comorbidity; D016001:Confidence Intervals; D003424:Crohn Disease / Q000188:drug therapy*; D003428:Cross Infection; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D006973:Hypertension / Q000139:chemically induced; D007008:Hypokalemia / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008606:Mental Processes / Q000187:drug effects; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids