Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Ioannis E. Koutroubakis; Claudia Ramos-Rivers; Miguel Regueiro; Efstratios Koutroumpakis; Benjamin Click; Robert E. Schoen; Jana G. Hashash; Marc Schwartz; Jason Swoger; Leonard Baidoo; Arthur Barrie; Michael A. Dunn; David G. Binion

doi:10.1016/j.cgh.2015.03.029

Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Ioannis E. Koutroubakis, Claudia Ramos-Rivers, Miguel Regueiro, Efstratios Koutroumpakis, Benjamin Click, Robert E. Schoen, Jana G. Hashash, Marc Schwartz, Jason Swoger, Leonard Baidoo, Arthur Barrie, Michael A. Dunn, David G. Binion^*

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

61 Scopus citations

Abstract

Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease. Methods: We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed. Results: A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (. P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (. P < .01), visits to gastroenterology clinics (. P < .001), telephone calls (. P < .004), surgeries for IBD (. P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (. P < .0001). Anemia was correlated negatively with quality-of-life scores (. P < .03). Conclusions: Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.

Original language	English (US)
Article number	54359
Pages (from-to)	1760-1766
Number of pages	7
Journal	Clinical Gastroenterology and Hepatology
Volume	13
Issue number	10
DOIs	https://doi.org/10.1016/j.cgh.2015.03.029
State	Published - Oct 1 2015

Funding

Funding Supported by a sabbatical salary from the Medical Faculty, University of Crete, Greece (I.K.), a National Institute for Diabetes and Digestive and Kidney Diseases grant ( 5T32DK063922-10 to B.C.), and by grant W81XWH-11-2-0133 from the US Army Medical Research and Material Command (M.D. and D.G.B.).

Keywords

C-Reactive Protein
Crohn's Disease
Erythrocyte Sedimentation Rate
Quality of Life
Ulcerative Colitis

ASJC Scopus subject areas

Gastroenterology
Hepatology

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10.1016/j.cgh.2015.03.029

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Koutroubakis, I. E., Ramos-Rivers, C., Regueiro, M., Koutroumpakis, E., Click, B., Schoen, R. E., Hashash, J. G., Schwartz, M., Swoger, J., Baidoo, L., Barrie, A., Dunn, M. A., & Binion, D. G. (2015). Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology, 13(10), 1760-1766. Article 54359. https://doi.org/10.1016/j.cgh.2015.03.029

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title = "Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease",

abstract = "Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease. Methods: We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed. Results: A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (. P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (. P < .01), visits to gastroenterology clinics (. P < .001), telephone calls (. P < .004), surgeries for IBD (. P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (. P < .0001). Anemia was correlated negatively with quality-of-life scores (. P < .03). Conclusions: Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.",

keywords = "C-Reactive Protein, Crohn's Disease, Erythrocyte Sedimentation Rate, Quality of Life, Ulcerative Colitis",

author = "Koutroubakis, {Ioannis E.} and Claudia Ramos-Rivers and Miguel Regueiro and Efstratios Koutroumpakis and Benjamin Click and Schoen, {Robert E.} and Hashash, {Jana G.} and Marc Schwartz and Jason Swoger and Leonard Baidoo and Arthur Barrie and Dunn, {Michael A.} and Binion, {David G.}",

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doi = "10.1016/j.cgh.2015.03.029",

language = "English (US)",

volume = "13",

pages = "1760--1766",

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publisher = "W.B. Saunders Ltd",

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Koutroubakis, IE, Ramos-Rivers, C, Regueiro, M, Koutroumpakis, E, Click, B, Schoen, RE, Hashash, JG, Schwartz, M, Swoger, J, Baidoo, L, Barrie, A, Dunn, MA & Binion, DG 2015, 'Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease', Clinical Gastroenterology and Hepatology, vol. 13, no. 10, 54359, pp. 1760-1766. https://doi.org/10.1016/j.cgh.2015.03.029

TY - JOUR

T1 - Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

AU - Koutroubakis, Ioannis E.

AU - Ramos-Rivers, Claudia

AU - Regueiro, Miguel

AU - Koutroumpakis, Efstratios

AU - Click, Benjamin

AU - Schoen, Robert E.

AU - Hashash, Jana G.

AU - Schwartz, Marc

AU - Swoger, Jason

AU - Baidoo, Leonard

AU - Barrie, Arthur

AU - Dunn, Michael A.

AU - Binion, David G.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease. Methods: We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed. Results: A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (. P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (. P < .01), visits to gastroenterology clinics (. P < .001), telephone calls (. P < .004), surgeries for IBD (. P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (. P < .0001). Anemia was correlated negatively with quality-of-life scores (. P < .03). Conclusions: Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.

AB - Anemia is a common manifestation of inflammatory bowel disease (IBD) that can greatly affect patients' quality of life. We performed a prospective study of a large cohort of patients with IBD to determine if patterns of anemia over time are associated with aggressive or disabling disease. Methods: We performed a longitudinal analysis of demographic, clinical, laboratory, and treatment data from a registry of patients with IBD at the University of Pittsburgh Medical Center from 2009 through 2013. Patients with a complete follow-up evaluation (at least 1 annual visit with laboratory results) were included. Anemia was defined by World Health Organization criteria. Disease activity scores (the Harvey-Bradshaw Index or the ulcerative colitis activity index) and quality-of-life scores (based on the short IBD questionnaire) were determined at each visit; laboratory data, including levels of C-reactive protein and erythrocyte sedimentation rates, as well as patterns of IBD-related health care use, were analyzed. Results: A total of 410 IBD patients (245 with Crohn's disease, 165 with ulcerative colitis; 50.5% female) were included. The prevalence of anemia in patients with IBD was 37.1% in 2009 and 33.2% in 2013. Patients with IBD and anemia required significantly more health care and had higher indices of disease activity, as well as a lower average quality of life, than patients without anemia (. P < .0001). Anemia (persistent or recurrent) for 3 or more years was correlated independently with hospitalizations (. P < .01), visits to gastroenterology clinics (. P < .001), telephone calls (. P < .004), surgeries for IBD (. P = .01), higher levels of C-reactive protein (in patients with ulcerative colitis, P = .001), and a higher erythrocyte sedimentation rate (. P < .0001). Anemia was correlated negatively with quality-of-life scores (. P < .03). Conclusions: Based on a longitudinal analysis of 410 patients, persistent or recurrent anemia correlates with more aggressive or disabling disease in patients with IBD.

KW - C-Reactive Protein

KW - Crohn's Disease

KW - Erythrocyte Sedimentation Rate

KW - Quality of Life

KW - Ulcerative Colitis

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JO - Clinical Gastroenterology and Hepatology

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Persistent or Recurrent Anemia Is Associated With Severe and Disabling Inflammatory Bowel Disease

Abstract

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