title: Predictors of ICU Admission and Outcomes 1 Year Post-Admission in Persons with IBD: A Population-based Study.
abstract: BACKGROUND
  To determine predictors of intensive care unit (ICU) admission and to assess health care utilization (HCU) post-ICU admission among persons with inflammatory bowel disease (IBD).
  
  
  METHODS
  We matched a population-based database of Manitobans with IBD to a general population cohort on age, sex, and region of residence and linked these cohorts to a population-based ICU database. We compared the incidence rates of ICU admission among prevalent IBD cases according to HCU in the year before admission using generalized linear models adjusting for age, sex, socioeconomic status, region, and comorbidity. Among incident cases of IBD who survived their first ICU admission, we compared HCU with matched controls who survived ICU admission.
  
  
  RESULTS
  Risk factors for ICU admission from the year before admission included cumulative corticosteroid use (incidence rate ratio, 1.006 per 100 mg of prednisone; 95% confidence interval, 1.004-1.008) and IBD-related surgery (incidence rate ratio, 2.79; 95% confidence interval, 1.99-3.92). Use of immunomodulatory therapies within 1 year, or surgery for IBD beyond 1 year prior, were not associated with ICU admission. In those who used corticosteroids and immunomodulatory medications in the year before ICU admission, the use of immunomodulatory medications conferred a 30% risk reduction in ICU admission (incidence rate ratio, 0.70; 95% confidence interval, 0.50-0.97). Persons with IBD who survived ICU admission had higher HCU in the year following ICU discharge than controls.
  
  
  CONCLUSIONS
  Corticosteroid use and surgery within the year are associated with ICU admission in IBD while immunomodulatory therapy is not. Surviving ICU admission is associated with high HCU in the year post-ICU discharge.
authors.affiliation: *Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; †IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; ‡Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and §Manitoba Centre for Health Policy, Winnipeg, MB, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
authors.forename: Christine A
authors.initials: CA
authors.lastname: Peschken
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Randy
authors.initials: R
authors.lastname: Fransoo
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D056747:Immunomodulation; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones