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Death from Crohn's disease. Lessons from a personal experience
R R Mendelsohn1, B I Korelitz, G W Gleim
1Department of Medicine, Lenox Hill Hospital, New York, NY 10021.
Insights
Crohn's disease can be virulent, characterized by early onset and aggressive complications. Early aggressive nonoperative therapy for severe cases warrants further evaluation to improve patient outcomes.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Epidemiology
Background:
- Crohn's disease is a chronic inflammatory bowel disease with significant morbidity and mortality.
- Understanding factors influencing outcomes in Crohn's disease is crucial for effective patient management.
Purpose of the Study:
- To identify mortality patterns and preceding events in hospitalized Crohn's disease patients.
- To define characteristics of a severe, "virulent" form of Crohn's disease.
- To evaluate the impact of early management strategies on patient outcomes.
Main Methods:
- Retrospective cohort study of 1,000 hospitalized Crohn's disease patients (1972-1987).
- Analysis of patient demographics, disease characteristics, treatments, and causes of death.
- Identification of events preceding mortality and their relation to Crohn's disease.
Main Results:
- 2.6% of patients (25/1000) died during the study period.
- Major causes of death related to Crohn's disease included "virulent" disease, gastrointestinal neoplasms, and complications in the elderly.
- 88% of deceased patients underwent surgery, with postoperative complications (sepsis, pulmonary embolism) contributing to mortality, particularly in elderly patients.
Conclusions:
- A subset of Crohn's disease patients exhibits a "virulent" phenotype associated with high mortality.
- Surgical interventions and complications, especially in older patients, are significant factors in Crohn's disease mortality.
- Early, aggressive nonoperative management for severe Crohn's disease requires further investigation and controlled trials.
Abstract:
We traced 1,000 patients with Crohn's disease hospitalized at Lenox Hill Hospital in New York City during 1972-1987 to identify those who died, the events preceding death, and their relationship to Crohn's disease. We considered any management early in the disease that might have influenced outcome. We introduce the term "virulent" Crohn's disease to describe those patients with most or all of the following: young age at onset, multiple surgical procedures, short bowel/malabsorption, chronic steroid therapy, narcotic addiction, and sepsis. Twenty-five patients (2.6%) had died. Major events preceding 18 deaths related to Crohn's disease were virulent Crohn's disease (six), gastrointestinal neoplasms (six), complications in the elderly (five), and complications of drug therapy (one). Those seven deaths probably unrelated to Crohn's disease were attributed to extraintestinal neoplasms (four) and myocardial infarction (three). Death was related to Crohn's disease or its treatment in 72% and perhaps in all. Ten of the 25 died at age 46 or younger (mean 36 years, range 25-46 years). Twenty-two (88%) who died had undergone surgery for Crohn's disease (mean 3.3 procedures) including eight who died postoperatively (six elderly), attributable to sepsis in seven and pulmonary embolism in one. The events preceding death suggest that early aggressive nonoperative therapy for severe Crohn's disease warrants a careful controlled evaluation.