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Serious Infections in Pediatric Inflammatory Bowel Disease 2002-2017-A Nationwide Cohort Study
Jonas F Ludvigsson1, Michael C Sachs2, Jacob Järås2
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Columbia University, New York, NY.
Insights
Children with inflammatory bowel disease (IBD) face a significantly higher risk of serious infections requiring hospitalization compared to the general population. This increased risk, particularly for opportunistic infections, necessitates careful monitoring and management in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Inflammatory bowel disease (IBD) affects children, increasing their susceptibility to infections.
- Understanding the infection risk in pediatric IBD is crucial for patient management.
Purpose of the Study:
- To compare the absolute and relative risks of serious infections in children with IBD versus the general population.
- To quantify infection risk across different IBD subtypes and over time.
Main Methods:
- Swedish nationwide health registry data (2002-2017) for children (<18 years) with IBD (n=5767) and matched controls (n=58,418).
- Cox regression analysis to estimate hazard ratios (HRs) for serious infections requiring inpatient care.
- Subgroup analyses for ulcerative colitis, Crohn's disease, and IBD unclassified.
Main Results:
- Children with IBD had a 9.46-fold increased risk of serious infections compared to controls (38.6 vs 4.0 per 1000 person-years).
- Elevated risks observed across all IBD subtypes, with IBD unclassified showing the highest HR (12.1).
- Risk was highest in the first year post-diagnosis (HR=12.6) and for those undergoing surgery; opportunistic infections risk was also significantly increased (HR=11.8).
Conclusions:
- Children diagnosed with IBD exhibit a substantially elevated risk of severe infections requiring hospitalization.
- The findings underscore the importance of infection surveillance and preventive strategies in pediatric IBD care.
Objective:
To assess absolute and relative risks of serious infections (resulting in inpatient care) in children with inflammatory bowel disease (IBD) compared with the general population.
Study Design:
We identified children (<18 years of age) with a first diagnosis of IBD in the Swedish nationwide health registry (2002-2017; n = 5767) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 58 418). Hazard ratios (HRs) for serious infections were estimated using Cox regression separately in children with ulcerative colitis (n = 2287), Crohn's disease (n = 2365), and IBD unclassified (n = 1115).
Results:
During 17 408 person-years of follow-up, 672 serious infections (38.6/1000 person-years) occurred among the children with IBD compared with 778 serious infections in the reference group (4.0/1000 person-years; adjusted HR (95% CI), 9.46 [8.53-10.5]). HRs were increased for children with ulcerative colitis 8.48 (7.21-9.98), Crohn's disease 9.30 (7.86-11.0), and IBD unclassified 12.1 (9.66-16.1). HRs were highest in the first year of follow-up (HR = 12.6 [10.7-14.9]), then decreasing to a 4.8-fold increased risk beyond 10 years of follow-up. Particularly high HRs were also seen in children with IBD undergoing surgery. Apart from a high relative risk of gastrointestinal infections resulting in hospitalization, children with IBD were also at an increased risk of opportunistic infections (HR = 11.8 [6.17-22.5]).
Conclusions:
Children with IBD have an increased risk of serious infection requiring hospitalization compared with the general population.
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