Increasing Rates of Infective Endocarditis in Patients with Inflammatory Bowel Disease

Introduction and aim Infective endocarditis (IE) cases are on the rise in the United States. The incidence of IE in patients with inflammatory bowel disease (IBD) has not been reported. Utilizing a national level database, we sought to estimate the incidence of IE in IBD-related hospitalizations and to determine its outcomes.  Methods Discharge records from the National Inpatient Sample were analyzed, and the International Classification of Diseases, ninth revision, Clinical Modification codes (ICD-9-CM) was used to identify adult patients with IBD (Crohn's disease or ulcerative colitis) and IE between 2003 and 2014. Trends in the incidence of IE were recorded and multivariable regression was used to determine the impact of IE on IBD-hospitalizations. Results The incidence of IE in patients with IBD rose from 14.5 cases per 10,000 admissions in 2003 to 21.7 in 2014. After multivariable adjustment, both patient groups with CD (odds ratio [OR] 3.5, 95% confidence interval [CI] 3.0-4.1) and UC (OR 2.9, 95% CI 2.5-3.5) admitted with IE were found to be at greater risk for in-hospital mortality compared to non-IE admissions. Patients with IBD admitted with IE were found to have greater mean length of stay (13 days vs. six days, p<0.0001) and higher average hospital charges ($36,869.85 vs. $13,324.01, p <0.0001) compared to non-IE admissions.  Conclusions Infective endocarditis is a growing complication in patients with IBD and is associated with increased mortality and utilization of healthcare resources. Further studies addressing the association between IE and IBD are needed.