Effect Of Steroid Use On The Clinical Course Of Crohn'S Disease Patients With Metabolic Syndrome Followed At A Tertiary Care Ibd Referral Center

Introduction: Prior studies have suggested that metabolic syndrome (MetS) may be associated with poor outcomes among patients with Crohn's disease (CD); however, it is unclear if certain medications worsen MetS and, thus, lead to more CD-related complications. The aim of this study was to determine if CD patients with MetS who were treated with steroids had worse outcomes than CD patients with MetS who did not receive steroids. Methods: Using a retrospective cohort study design, we selected patients >19 years old with a concomitant diagnosis of CD and MetS (CD/MetS) seen at our institution's IBD center between 2000 and 2012. We evaluated CD/MetS patients treated with steroids during observation and compared rates of hospitalization to CD/MetS patients without steroid use. Summary statistics were generated and compared between the two groups using t-test for continuous variables and Chi-square test for character variables. Incidence rates (IR) were calculated for each group by dividing number of hospitalizations by person-years. Poisson regression was used to calculate crude IR ratio (IRR), and demographic variable, co-morbidities and medication use adjusted IRR and their confidence intervals. 95% confidence interval for IRR that did not include 1.0 was considered significant. Results: Of the 846 patients with CD identified, 36 had MetS. Of these 36 patients, 17 were given steroids during observation. The incidence rate of hospitalization for a CD related exacerbation was 53/100 person-years among CD/MetS patients treated with steroids vs. 20/100 person-years among CD/MetS patients not treated with steroids. Partially adjusted Generalized Poisson Regression Model for Rate Data showed CD/MetS patients treated with steroids had more than three times higher admission rates for a CD-related exacerbation during their disease course compared to CD/MetS patients not treated with steroids (IRR 3.34 95%CI=1.78-6.25). Fully adjusted Generalized Poisson Regression Model for Rate Data showed CD/MetS patients treated with steroids were 7.5 times more likely to be admitted for a CD-related exacerbation during their disease course compared to CD/MetS patients who did not receive steroids (IRR 7.52 95%CI=1.26-44.77). Conclusion: Steroid use is associated with increased risk for hospitalization among CD patients with MetS. Further investigation will help elucidate the potentially deleterious effect of steroid use in this specific population.