P0507 - Chronic Depression Is Associated With Negative Outcomes in Patients Admitted for Inflammatory Bowel Disease

Paul T. Kroner, MD, MSc, Joshua Kwon, MD, Pedro Palacios, MD, Jana Hashash, MD, MSc, Michael Picco, MD, PhD, Francis A. Farraye, MD, MSc
Mayo Clinic, Jacksonville, FL

Introduction: Inflammatory bowel disease (IBD) is a known risk factor for the development of mental illness, including depression. However, a bidirectional relationship between IBD and depression has also been recognized, in which depression not only affects a patient’s quality of life but influences the use of healthcare and efficacy of IBD treatment. Therefore, the aim of this study is to assess the outcomes of patients admitted for IBD who had an associated diagnosis of chronic depression.

Methods: Observational, retrospective study using the NIS 2016 and 2017. International Classification of Diseases – Clinical Modification (ICD-CM) diagnostic codes were used to identify all patients with a principal diagnosis of IBD. Patients with chronic depression were identified using respective ICD codes. The primary outcome was the odds of inpatient mortality in patients with IBD and depression compared to patients with IBD and no depression. Secondary outcomes included morbidity measures and inpatient resource utilization. Multivariate regression analysis was used to adjust for gender, age, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status.

Results: A total of 205,074 patients admitted for IBD were identified, out of which 670 (0.33%) had associated diagnosis of chronic depression. The mean age in patients with and without depression was 41.1 and 42.8 years, while 54.1% and 45.9% were female, respectively. For the primary outcome, although patients with IBD and depression did display increased mortality adjusted odds ratio (aOR) of 3.63, it did not reach statistical significance. Of the morbidity measures, patients with IBD and depression displayed increased odds of shock (aOR 4.65, p< 0.01), as well as increased additional adjusted hospitalization costs, hospitalization charges and length of hospitalization compared to patients with IBD without chronic depression.

Discussion: Chronic depression in patients with IBD was associated with increased odds of shock, hospital costs, hospitalization charges and hospitalization length of stay compared to patients with IBD and no chronic depression. This study highlights the importance of routine assessment and treatment of clinical depression as a health maintenance measure in patients with IBD. However, taking disease severity into account will be of paramount importance in future studies. Therefore, the inclusion of mental health providers to the IBD multidisciplinary care team is of paramount importance.

	Adjusted Odds Ratio	95% Confidence Interval	p-value
Mortality	3.63	0.44-30.06	0.23
Shock	4.65	1.66-13.01	< 0.01
ICU stay	1.20	0.16-8.94	0.86
AKI	1.46	0.76-2.82	0.26
SIRS	1.29	0.41-4.08	0.66
Sepsis	1.52	0.38-6.07	0.56
Multiorgan Failure	1.53	0.81-2.89	0.19
	Adjusted Means	95% Confidence Interval	p-value
Additional Adjusted Costs	$8,181	3873,12490	< 0.01
Additional Adjusted Costs	$23,722	7695-39749	< 0.01
Additional Adjusted LOS (days)	4.4	2.5-6.3	< 0.01

Table: Table 1 – Adjusted odds ratio and adjusted means for selected variables in patients with IBD and chronic depression compared to patients with IBD and no chronic depression. *ICU: Intensive care unit; AKI: Acute kidney injury; SIRS: Systemic inflammatory response syndrome; LOS: length of stay


Disclosures:
Paul Kroner indicated no relevant financial relationships.
Joshua Kwon indicated no relevant financial relationships.
Pedro Palacios indicated no relevant financial relationships.
Jana Hashash indicated no relevant financial relationships.
Michael Picco indicated no relevant financial relationships.
Francis Farraye indicated no relevant financial relationships.


Paul T. Kroner, MD, MSc, Joshua Kwon, MD, Pedro Palacios, MD, Jana Hashash, MD, MSc, Michael Picco, MD, PhD, Francis A. Farraye, MD, MSc. P0507 - Chronic Depression Is Associated With Negative Outcomes in Patients Admitted for Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.