S1557 Probiotic Use as Adjunct Therapy in Hospitalized IBD Patients: Impact on Clinical Outcomes

Introduction: Probiotic use in hospitalized patients with inflammatory bowel disease (IBD) is debated due to its potential impact on clinical outcomes. This study aims to assess the effect of probiotics on IBD-related outcomes, including mortality, colon cancer, colectomy, Clostridioides difficile infection, intraabdominal abscess, fistula formation, toxic megacolon, and hospitalizations, using a large cohort of propensity score-matched patients. Methods: A retrospective cohort study was conducted using TriNetX. Adult IBD patients were grouped into 2 cohorts: those who received probiotics (Cohort A) and those who did not (Cohort B). Propensity score matching controlled for confounders like age, sex, race, smoking, and disease severity. Primary outcomes included the IBD-related outcomes mentioned above. Results: The probiotic group had a significantly higher mortality risk (Risk Difference = 0.017, P = 0.002), with a hazard ratio of 1.153 (P = 0.000), indicating a 15.3% increased risk of death. However, survival probability overall was higher in the probiotic group (72.30%) than the non-probiotic group (61.36%). There were no significant differences in colon cancer (Risk Difference = -0.001, P = 0.430) or colectomy risk (Risk Difference = 0.004, P = 0.061). The probiotic group had a significantly higher risk of C. difficile infection (Risk Difference = 0.037, P = 0.000), with a hazard ratio of 2.152 (P = 0.007). Similarly, the probiotic group had higher risks of intraabdominal abscess (Risk Difference = 0.006, P = 0.010) and fistula formation (Risk Difference = 0.010, P = 0.000). Only 10 probiotic patients developed toxic megacolon (P = 0.002), while hospitalization risk was slightly higher (Risk Difference = 0.008, P = 0.136). Conclusion: Probiotic use in hospitalized IBD patients was associated with an increased risk of mortality, C. difficile infection, intraabdominal abscess, fistula formation, and toxic megacolon, despite a higher survival probability overall. These findings suggest the need for careful consideration of probiotic therapy, especially in hospitalized patients at high risk for complications. Further research is needed to explore the mechanisms linking probiotics to adverse events, including effects on the gut microbiome and immune response, and to identify patient-specific factors that may influence these outcomes.