Introduction: The development of inflammatory bowel disease (IBD) is multifactorial. A risk factor for IBD is stress from anxiety. Generalized anxiety disorder (GAD), a prevalent form of anxiety, is twice as common in IBD patients. This study explores the outcomes of adults hospitalized for IBD with comorbid GAD.
Methods: Adults hospitalized for IBD were selected from the 2014 National Inpatient Sample database. ICD-9 codes were used to select diagnoses. Demographic data and outcomes of IBD were compared between a subgroup with GAD and a subgroup without GAD. The outcomes of interest were hypotension/shock, sepsis, acute hepatic failure, acute respiratory failure, acute renal failure (AKI), myocardial infarction (MI), acute deep vein thrombosis (DVT), ileus, inpatient mortality, colectomy, intestinal abscess, obstruction, and perforation. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. A multivariate logistic regression analysis was used to establish if GAD is an independent predictor for the outcomes, after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI).
Results: Among 24,773 IBD patients, 3,400 also had GAD. Patients with comorbid GAD were more likely to be younger (54.8 vs. 55.9 years old, p< 0.001), to be female (68.6% vs. 46.3%, p< 0.001), to be white (86.1% vs. 76.7%, p< 0.001), to have a lower hospitalization cost ($56,313 vs. $68,784, p< 0.001) and a lower CCI (2.45 vs. 2.65, p< 0.001). There was no significant difference in length of stay (6.6 vs. 6.8 days, p=0.264). After adjusting for age, sex, race, and CCI, GAD was found to be a risk factor for sepsis (adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.17-1.50, p< 0.001), acute hepatic failure (aOR 1.80, 95% CI 1.18-2.73, p=0.006), acute respiratory failure (aOR 1.24, 95% CI 1.04-1.49, p=0.018), inpatient mortality (aOR 1.87, 95% CI 1.50-2.31, p< 0.001), intestinal abscess (aOR 2.35, 95% CI 1.20-4.61, p=0.013) and perforation (aOR 1.44, 95% CI 1.06-1.95, p=0.019). The aORs were not statistically significant for hypotension/shock (p=0.306), AKI (p=0.083), MI (p=0.278), DVT (p=0.972), ileus (p=0.613), colectomy (p=0.760), and obstruction (p=0.129).
Discussion: In IBD patients, GAD is a risk factor for sepsis, acute hepatic failure, acute respiratory failure, intestinal abscess, perforation, and inpatient mortality. The worse outcomes may be attributable to the microbiome disruption as well as poor medication compliance associated with GAD.
