Serologic, Genetic, and Clinical Associations with Increased Healthcare Resource Utilization in Inflammatory Bowel Disease

Gu P1, Kapur A2, Li D2, Haritunians T2, Vasiliauskas E2, Shih DQ2, Targan SR2, Spiegel BMR3, McGovern DPB2, Black JT4, Melmed GY2. J Dig Dis. 2017 Dec 18. doi: 10.1111/1751-2980.12566. [Epub ahead of print]
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1 Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

2 F Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.

3 Center for Outcomes Research and Education, Cedars-Sinai Health System, Los Angeles, CA.

4 Resource & Outcomes Management Department, Cedars-Sinai Health System, Los Angeles, CA.


BACKGROUND: Inflammatory bowel diseases (IBD) are associated with significant morbidity and economic burden. The highly variable course of IBD creates a need for accurate predictors of clinical outcomes and health resource utilization (HRU) to guide treatment decisions early in the disease course.

OBJECTIVE: We aimed to identify clinical, serologic and/or genetic markers associated with inpatient resource utilization in patients with ulcerative colitis (UC) and Crohn's disease (CD).

METHODS: IBD patients with available genetic and serologic data who had at least one emergency department (ED) visit or hospitalization in a 3 year period were included. The primary outcome measure was HRU, as measured by the All-Patient-Refined Diagnosis-Related-Group classification system. Univariate and multivariate linear and logistic regression models were used to identify clinical, serologic and genetic associations with HRU.

RESULTS: 858 patients (562 CD) were included. Anti-CBir1 seropositivity (p = 0.002, ES: 0.762 [95% CI 0.512 to 1.012]) and low socioeconomic status (SES) (p = 0.005, ES: 1.620 [95% CI 1.091 to 2.149]) were independently associated with higher HRU. CD diagnosis(p = 0.006, ES: -0.701 [95% CI -0.959 to -0.443]) was independently associated with lower inpatient HRU.

CONCLUSIONS: Anti-CBir1 antibody seropositivity and low SES were independently associated with higher inpatient HRU, while CD diagnosis was independently associated with lower inpatient HRU in a cohort of IBD patients who required at least one ED visit or hospitalization. If verified by future studies, anti-CBir1 antibody status may be a useful biomarker of HRU when formulating management strategies to reduce diseasecomplications and resource utilization.

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