AI Predicts Premature Death in Patients With IBD

Almost half of patients who died with inflammatory bowel disease (IBD) died prematurely, and artificial intelligence (AI) can predict these premature deaths, according to new data.

In a population-based cohort study that included more than 9000 decedents with IBD, chronic conditions developed at or before age 60 years were associated with premature death, which was defined as death at an age younger than 75 years.

The findings emphasize the need for early intervention in these individuals, study author Eric Benchimol, MD, PhD, a pediatric gastroenterologist and senior scientist at the Hospital for Sick Children and the SickKids Research Institute in Toronto, told Medscape Medical News. 

Intervention is necessary to ensure that these patients have access to high-quality, multidisciplinary healthcare, he explained. “Chronic conditions developed early in life may be more important in determining a patient’s health course.”

The study was published on March 24 in CMAJ.

Extraintestinal Manifestations

Canada has among the highest incidence and prevalence of IBD in the world. By 2035, about 470,000 people in Canada, or 1 in 91 individuals, will be living with IBD. It is important to understand the predictors of premature death to improve care for these patients, said Benchimol.

The investigators examined administrative health data for all patients with IBD who died between 2010 and 2020 in Ontario. Using validated algorithms for health administrative data, the researchers identified patients with a history of chronic conditions such as asthma, congestive heart failure, and diabetes. Next, the researchers developed statistical and machine learning models to predict premature death from the presence of 17 chronic conditions and the patient’s age at diagnosis.

Almost half (47.2%) of the 9278 deaths that occurred among patients with IBD during the 10-year period that the researchers examined were premature. The rate of premature death was higher in men (50%) than in women (44%).

The most common chronic conditions at death were arthritis (77%), hypertension (73%), mood disorders (69%), kidney failure (50%), and cancer (46%). “That’s not surprising, as many of those [conditions] are considered extraintestinal manifestations of IBD, and having IBD puts you at risk for these conditions,” said Benchimol.

Being diagnosed with these conditions before age 60 years was the most important predictor of premature death. “This [finding] held true across all the different models we used, so it seems if you are diagnosed with multiple comorbidities beyond your IBD, then you’re much more likely to die before the age of 75 years,” said Benchimol.

“We think death before 75, premature death, is preventable. That’s the theory among people who study chronic diseases and geriatrics, so if we can treat patients early for their other chronic comorbidities, perhaps we can prevent early death in patients with IBD,” he added.

“Another big message here is that we can no longer think of IBD as the domain of a gastroenterologist alone. It has to be something that requires multidisciplinary care. We need to easily and seamlessly integrate physicians, psychologists, social workers, nutritionists, and dieticians to provide better care in young and middle-aged adults so that they will have an easier course going forward,” Benchimol continued.

Young adults may not see their doctor often. If their IBD is controlled, then they may not need to see a physician as frequently as other patients. As a result, young adults may not get the preventive care that they should be getting, noted Benchimol.

“Gastroenterologists need to broaden their focus and perhaps start to screen for and identify these chronic diseases as they are occurring early so that we can work with other healthcare providers to treat those chronic diseases properly,” Benchimol said.

A New Stethoscope?

Commenting on the findings for Medscape Medical News, John-Jose Nuñez, MD, associate medical director of supportive care at BC Cancer in Vancouver, said, “Machine learning algorithms give us a better understanding of how different factors combine to affect outcomes.” Nuñez did not participate in this study.

“Sometimes, it will even help us figure out some things that we might not even know are risk factors. For example, in this paper, one of the things they looked at was mood disorders like depression and anxiety. Some doctors may not know that these could put IBD patients at risk. It was interesting to see the authors include mood disorders as a potential risk factor,” said Nuñez.

“Medicine continues to become more and more complicated. I spent about 16 years in university to become a subspecialist in my field of medicine, and we are starting to reach the limit of human intelligence and human capacity to think about medical problems and to utilize all the data that may influence a clinical decision,” he added.

“AI is a potential way to extend our cognitive capacity and could become an important assistant helping us care for our patients,” Nuñez said. Yet AI will not replace human doctors anytime soon.

“It will be a tool that will become increasingly widespread. I like to compare it to the stethoscope, a now-ubiquitous tool that also was viewed with skepticism when it was initially used. Like any tool, it comes with new cautions and considerations, of course, but like the stethoscope, it will help improve the care we can provide our patients,” he said.

The study received funding from the Temerty Centre for Artificial Intelligence Research and Education in Medicine 2022 summer studentship and the 2023 American College of Gastroenterology Medical Student Research Award. Benchimol reported having no relevant financial relationships. Nuñez reported a financial relationship with Amazon Canada.