CORTICOSTEROID-ASSOCIATED COMPLICATIONS IN ELDERLY CROHNS-DISEASE PATIENTS

Objectives: Although complications occur with longterm steroid usage i n elderly Crohn's disease patients, there is little information on the ir short-term risk. This study was designed to assess that risk. Metho ds: We reviewed admissions from 1984 to 1995 and found 115 patients ov er age 50 yr with a confirmed flare of Crohn's disease. Of this group, 55 patients were treated with steroids. We studied potential complica tions including hypertension (blood pressure greater than or equal to 160/90), hyperglycemia (glucose >200 mg/dl), hypokalemia (K < 3.5 meg/ l), mental status changes, nosocomial infections, and heart failure. R esults: The mean age was 67 yr (50-90), and 64% were women. There were no differences in baseline characteristics between patients treated w ith steroids and those not treated with steroids. The relative risk fo r developing complications are as follows: hypertension, 1.46 (95% con fidence interval (CI) = 1.09-1.95), hyperglycemia, 1.53 (95% CI = 0.54 -4.32), hypokalemia, 1.59 (95% CI = 1.06-2.37), mental status changes, 7.64 (95% CI = 0.97-60.1), nosocomial infection, 1.09 (95% CI = 0.37- 3.18), and congestive heart failure, 1.09 (95% CI = 0.16-7.48). Multiv ariate analyses adjusting for age, severity index, and number of comor bid conditions demonstrated similar findings to the unadjusted analyse s. Analyses stratified by patient age demonstrated a similar risk of s teroid associated complications for patients < 65 and <greater than or equal to < 65 yr of age. Conclusion: Crohn's disease patients over ag e 50 yr treated with steroids are at significantly increased risk for developing hypertension and hypokalemia and at increased risk for deve loping mental status changes, but such steroid-effects were not more p ronounced with advancing age.