Gut inflammation tied to nearly 50% higher death risk in IBD patients

<p><strong>BACKGROUND AND AIMS: </strong>Inflammatory bowel disease (IBD) is associated with increased mortality risk. However, whether this risk is influenced by histologic and clinical activity remains uncertain.</p><p><strong>METHODS:</strong> A nationwide cohort study in Sweden. We compared mortality rates linked to histologic inflammation in 63,358 patients diagnosed with IBD 1969-2017 and to clinical activity in 102,352 patients diagnosed 1969-2020. The adjusted hazard ratio (aHR) of mortality within 2 years after index date (i.e., date of histologic/clinical activity) was estimated using cause-specific hazard model, with 95% confidence intervals (CIs).</p><p><strong>RESULTS:</strong> A higher 2-year all-cause mortality was observed after histologic inflammation than after histologic remission (incidence rates [IRs]: 121.0 vs. 64.8 per 10,000 person-years; aHR=1.45; 95%CI: 1.30 to 1.61). This excess risk was observed in all IBD subtypes: Crohn's disease (aHR=1.42 [1.16 to 1.73]), ulcerative colitis (aHR=1.44 [1.26 to 1.65]), and IBD-unclassified (aHR=1.56 [1.01 to 2.41]). Clinically active IBD was also associated with an increased 2-year all-cause mortality compared to quiescent IBD (IR: 352.6 vs. 106.3 per 10,000 person-years; aHR=3.35 [3.21 to 3.49]). Even in patients with clinically quiescent IBD, histologic inflammation was associated with an increased 2-year all-cause mortality (aHR=1.42 [1.08 to 1.87]).</p><p><strong>CONCLUSIONS:</strong> Both histologic inflammation and clinical activity of IBD were associated with increased all-cause mortality, suggesting that improved disease control may reduce mortality risk in IBD.</p>