Prevalence and Predictors of Stroke in Patients with Crohn's Disease: A Nationwide Study

Objectives: Mounting evidence points to the microbiome as a susceptibility factor for neurological disorders. Patients with Crohn's disease (CD) are at higher ischemic stroke (IS) risk, but no large scale epidemiologic studies have identified risk factors for stroke in this population. Materials and Methods: We analyzed the 2017 Nationwide Inpatient Sample (NIS) dataset to identify patients with a discharge diagnosis of Crohn's disease using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code K50.X. We identified patients with a primary/secondary discharge diagnosis of IS using ICD-10-CM code I63.X. We compared sociodemographic and clinical variables between stroke and non-stroke patients with CD. Logistic regression analysis was applied to identify factors associated with IS. Results: Of 30,212 patients with CD, 369 (1.2 %) had a discharge diagnosis of IS. Older age (odds ratio [OR], 1.03 [95% CI, 1.02–1.04], top quartile income (OR, 1.58 [95% CI, 1.10–2.30]), and hospitalization in a South Atlantic (OR, 1.82 [95% CI, 1.11-3.14]), East South Central (OR, 2.30 [95% CI, 1.28-4.25]), or West South Central hospital (OR, 2.40 [95% CI, 1.39-4.28]) were independently associated with IS. Clinical variables independently associated with IS in patients with CD included: atrial fibrillation (OR, 1.66 [95% CI, 1.15-2.33]), atherosclerosis (OR, 2.41 [95% CI, 1.32-4.10]), hyperlipidemia (OR, 1.69 [95% CI, 1.33-2.15]), hypertension (OR, 1.53 [95% CI, 1.18-1.98]) and valvular disease (OR, 1.62 [95% CI, 1.01-2.48). Conclusion: A subset of traditional stroke risk factors are associated with IS in patients with CD. CD patients with these conditions could be targeted for vascular risk reduction and surveillance.