title: Increased incidence of critical illness among patients with inflammatory bowel disease: a population-based study.
abstract: OBJECTIVE
  Little is known about how often, and for what reasons, patients with inflammatory bowel diseases (IBD) are admitted to the intensive care unit (ICU). We compared incidences of ICU admission, characteristics of critical illness, and mortality after ICU admission between patients with IBD and the general population.
  
  
  METHODS
  We identified all persons with IBD in the province of Manitoba using a validated administrative definition of IBD for the period from 1984 to 2010. Cases were considered incident for IBD if their first health system contact for IBD was in 1989 or later. We identified a population-based control group, matched by age, sex, and geography (based on postal code). Case and control cohorts were linked to the Manitoba ICU database. We compared outcomes between groups using age- and sex-standardized rates, Cox proportional hazards models, and logistic regression models, adjusting for age, sex, comorbidity, and socioeconomic status.
  
  
  RESULTS
  There were 8224 prevalent and 4580 incident cases of IBD. After adjustment, the risk for ICU admission was higher for patients with IBD than controls (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.58-2.02). The risk of ICU admission was higher for patients with Crohn's disease (HR, 2.31; 95% CI, 1.95-2.75) than ulcerative colitis (HR, 1.37; 95% CI, 1.13-1.65). From 2000 through 2010, age- and sex-standardized annual incidence rates for ICU admission in the prevalent IBD cohort ranged from 0.55% to 1.12%. Compared with controls admitted to ICUs, 1 year after ICU admission, mortality was 32% among patients with IBD.
  
  
  CONCLUSIONS
  Patients with IBD have a higher risk for admission to the ICU than the general population, and increased mortality 1 year after admission. These findings underscore the potential severity of IBD.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.affiliation: Manitoba Centre for Health Policy, Winnipeg, Canada.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Manitoba Centre for Health Policy, Winnipeg, Canada.
authors.forename: Randall
authors.initials: R
authors.lastname: Fransoo
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Canada. Electronic address: charles.bernstein@med.umanitoba.ca.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
keywords: Administrative Data; Critical Illness; Incidence; Inflammatory Bowel Disease