A study found that adults with inflammatory bowel disease had a higher risk of hospitalization due to respiratory syncytial virus infection compared to those without inflammatory bowel disease.
After propensity score matching, patients in the IBD-RSV cohort showed a 30% increased risk of hospitalization compared to the non–IBD-RSV cohort (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.06-1.59, P = .009). The risk was particularly elevated in patients aged 18 to 49 years (aOR = 1.73, 95% CI = 1.15-2.60, P = .007) and those aged 65 years or older (aOR = 1.43, 95% CI = 1.03-1.99, P = .02).
The study found that in total, 45.4% of patients in the IBD-RSV cohort required hospitalization. Among these, 59% were female, 77% were White, and the mean age was 58.7 ± 19.9 years. In the overall IBD-RSV cohort, the mean age was 55.6 ± 20 years, 59% were female, 80% were White, and 56.9% had Crohn's disease.
Comorbidities in the IBD-RSV cohort included diabetes mellitus (30.2% of patients), obesity (24%), chronic lower respiratory diseases (54.4%), ischemic heart disease (30.8%), heart failure (23.7%), and chronic kidney disease (26.5%). Subgroup analysis revealed an increased risk of hospitalization in patients with Crohn's disease (aOR = 1.51, 95% CI = 1.15-1.97) but not in those with ulcerative colitis (aOR = 1.05, 95% CI = 0.79-1.38). Patients with IBD and cardiovascular disease showed a significantly higher risk of hospitalization (aOR = 3.35, 95% CI = 2.10-5.33, P < .0001) compared to patients with IBD without cardiovascular disease. Recent systemic corticosteroid use—defined as taking the agents within the past 3 months—was also associated with an increased risk of hospitalization (aOR = 1.86, 95% CI = 1.30-2.59, P = .0005). The study did not find a significant difference in hospitalization risk for patients with IBD taking tumor necrosis factor inhibitors (TNFi) (aOR = 0.92, 95% CI = 0.52-1.61, P = .77) or immunomodulators (aOR = 1.40, 95% CI = 0.84-2.35, P = .19) compared to those receiving 5-aminosalicylic acid therapy.
Regarding complications during hospitalization, there was no significant difference between the IBD-RSV and non–IBD-RSV cohorts. The composite outcome of complications occurred in 23.7% of patients in the IBD-RSV cohort versus 27% of those in the non-IBD-RSV cohort (aOR = 0.83, 95% CI = 0.58-1.19). Specific complications included:
- Intensive care unit admission: 15.5% vs 19.9% (aOR = 0.73, 95% CI = 0.48-1.11)
- Respiratory support: 11.3% vs 13.6% (aOR = 0.81, 95% CI = 0.50-1.31)
- Vasopressor support: 3.1% in both cohorts (aOR = 1.00, 95% CI = 0.41-2.43)
- Mortality: 4.7% vs 4.1% (aOR = 1.16, 95% CI = 0.54-2.48).
The mean length of hospital stay was 6.4 days for the IBD-RSV cohort versus 7 days for the non–IBD-RSV cohort (P = 0.38).
Among hospitalized IBD-RSV patients, medication use included mesalamine (39%), TNFi (21%), thiopurines (20%), methotrexate (6%), ustekinumab (3%), vedolizumab (6%), and tofacitinib (3%).
The researchers used ICD-10-CM codes and laboratory test results to identify RSV cases. Most tests (90.3%) were molecular-based, while 9.7% were antigen-based. To ensure RSV was the cause of hospitalization, researchers required a hospitalization code to occur within 7 days of a positive test or RSV-specific ICD-10 code. Most hospitalizations occurred within 24 hours of a positive RSV test or RSV-specific ICD-10 code, with only 14.3% of patients hospitalized before RSV diagnosis.
The study's limitations included potential misclassification bias, residual confounding, and difficulties in capturing social and economic factors that may affect outcomes. Additionally, the researchers noted that RSV testing is not routinely conducted for all respiratory infections, which may lead to underreporting of cases.
The study authors concluded, "We found that adult patients with IBD and RSV infection are at an increased risk of hospitalization and may benefit from the new RSV vaccine recommended for adults aged 60 years and older."
Conflict of interest disclosures can be found in the study.