Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis

John Nicholls (1) , David Clark (2) , Laura Kelso (2) , Alison Crowe (3) , Alastair Knight (4) , Paul Hodgkins (5) , Jack Satsangi (6)

1 BSST - Department of Biosurgery and Surgical Technology
2 Information Services Division
3 Corvus
4 Corvus
5 Global Health Economics & Outcomes Research
6 GI Unit, Molecular Medicine Centre

Background Recent data associated higher mortality with medical rather than surgical intervention in ulcerative colitis (UC) patients requiring hospitalisation. Factors influencing UC-related mortality in Scotland were examined. Method Using the national record linkage database 1998-2000, three year mortality was determined after four admission types: colectomy elective, emergency; no colectomy elective, emergency. Results Of 1078 patients crude three year mortality rates were: colectomy elective 5.6% (177) and emergency 9.0% (100); no colectomy elective 9.8% (244) and emergency 16.0% (557). Using elective colectomy as reference, multivariate analysis (OR ([95% CI]) showed admission age >50 years (OR 5.46 [2.29-11.95]), male gender (OR 1.92 [1.23-3.02]), comorbidity (OR 2.2 [1.38-3.51]), length of stay >15 days (OR 2.04 [1.08-3.84]) and prior IBD admission (OR 1.66 [1.06-2.61] were independently related to mortality. Age was the strongest determinant. No patient <30 years died. Mortality <50 years (10/587 [1.7%]) was significantly lower than 50-64 (26/246 [10.6%]) (2 = 32.91;p<0.0000001) and >65 (96/245 [39.2%]) (2 = 218.2;p<0.0000001). Over 65, mortality in the four groups was 29.4%, 33.3%, 28.1% and 44.7%; greater than expected in the Scottish population. Conclusion Hospital admission in UC patients >65 is associated with high mortality. Management strategies in these patients require detailed re-assessment.

Mots clés: Medicine

John Nicholls, David Clark, Laura Kelso, Alison Crowe, Alastair Knight, et al.. Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitis. Alimentary Pharmacology and Therapeutics, 2010, 31 (12), pp.1310. ⟨10.1111/j.1365-2036.2010.04302.x⟩. ⟨hal-00552551⟩