Patients with IBD, particularly Crohn’s disease, were more likely to develop pneumonia than those without IBD, with certain medications also heightening risk for the illness in a recent study.
In a retrospective cohort study, researchers assessed the risk for pneumonia among 50,932 patients with Crohn’s disease (CD), 56,403 with ulcerative colitis (UC) and 1,269 with unspecified IBD, along with that of 434,416 matched controls, over a median follow-up of 24 months (range 1-138 months). A nested case-control analysis also was performed, in which the medication use of 4,856 patients with IBD and pneumonia was compared with that of 18,928 matched IBD patients without pneumonia.
Investigators determined an overall annual incidence of pneumonia of 138 cases per 100,000 patients, compared with 76 per 100,000 patients among those without IBD. Patients with IBD were at significantly increased risk for developing pneumonia compared with those without IBD (IRR=1.82; 95% CI, 1.75-1.88), with a particularly elevated risk observed among those with comorbidities.
After adjusting for confounders including comorbidities, proton-pump inhibitor (PPI) use and health care utilization, pneumonia risk remained elevated for IBD overall (HR=1.54; 95% CI, 1.49-1.60) and specifically for those with CD (HR=1.71; 95% CI, 1.62-1.80) and UC (HR=1.41; 95% CI, 1.34-1.48).
Results from the nested case-control analysis indicated associations between pneumonia risk and use of PPIs (adjusted OR=1.15, 1.04-1.26), corticosteroids (aOR=1.91, 1.72-2.12), biologics (aOR=1.32, 1.11-1.57) and narcotics (aOR=2.28, 2.09-2.48) (95% CI for all). Stratification according to the presence of CD or UC yielded similar results.
Millie D. Long
“Patients with IBD are at increased risk for pneumonia, and corticosteroids particularly increase this risk,” researcher Mille D. Long, MD, MPH, assistant professor of medicine, gastroenterology and hepatology division at University of North Carolina, Chapel Hill, told Healio.com. “The risk of pneumonia in Crohn’s disease is on par with that of diabetes, and therefore we need to improve vaccination efforts. … As a gastroenterology community, we need to focus upon prevention of this complication, via vaccination and, potentially, reduction of risk factors (such as prescriptions for corticosteroids and/or narcotics).”