S1492 Trends, Burden and Impact of Infections on Outcomes in Patients With Ulcerative Colitis: A Nationwide Analysis

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation in the colon. Patients with UC are predisposed to infections due to underlying immune dysfunction and immunosuppressive therapy. This study investigates recent trends, burden, and the clinical impact of infections among hospitalized UC patients. Methods: The National Inpatient Sample database 2016-2022 was used to identify adult patients with UC. Patients were stratified into 2 groups—those with and without infections. We collected data on patient demographics, comorbidities, types of infections, and clinical outcomes. The study outcomes included in-hospital mortality, sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) stay, blood transfusions, and surgical procedures. A multivariate logistic/linear regression analysis was used to assess the impact of infections on these outcomes. Results: Among the 826,945 patients diagnosed with UC, 216,595 (26.2%) developed infections. The most frequent infections observed include UTI (9.2%), hospital-acquired pneumonia (HAP) (7.0%), and Clostridioides difficile infection (CDI) (6.2%). From 2016-2022, rising trends were noted in HAP, cholangitis and bacteremia, while the trends among UTI remained stable. Infections were associated with significantly worse clinical outcomes, including in-hospital mortality (4.9% vs 1.3%), sepsis (5.9% vs 2.7%), AKI (28.5% vs 14.8%), shock (9.2% vs 2.6%), ICU admissions (7.0% vs 2.3%), blood transfusions (0.7% vs 0.3%), but decreased rates of surgical procedures (2.6% vs 4.9%). After adjusting for confounding factors, patients with infections had higher odds of in-hospital mortality (aOR-2.87, 95% CI-2.68-3.08, P < 0.001), sepsis (aOR-2.24, 95% CI-2.12-2.37, P < 0.001), AKI (aOR-1.84, 95% CI-1.78-1.89, P < 0.001), shock (aOR-3.18, 95% CI-3.02-3.35, P < 0.001), ICU admissions (aOR-2.74, 95% CI-2.60-2.93, P < 0.001), blood transfusions (aOR-1.98, 95% CI-1.68-2.32, P < 0.001), but decreased odds of surgical procedures (aOR-0.68, 95% CI-0.63-0.73, P < 0.001). Conclusion: Our study reveals that infections significantly worsen clinical outcomes and increase healthcare utilization in UC patients. Therefore, prevention, early identification and management of infections are critical in improving patient prognosis.