TY - JOUR
T1 - How does cirrhosis impact mortality, morbidity, and resource utilization in non-variceal upper gastrointestinal bleeding? A nationwide analysis
AU - Farooq, Umer
AU - Tarar, Zahid Ijaz
AU - Malik, Adnan
AU - Amin, Muhammad Kashif
AU - Sifuentes, Humberto
N1 - Publisher Copyright:
© 2023 Termedia Publishing House Ltd.. All rights reserved.
PY - 2023
Y1 - 2023
N2 - Introduction: Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database. Aim: To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis. Material and methods: This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student’s t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. Results: Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, p < 0.001, ICU admission AOR = 1.29, p < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (p < 0.001), greater hospital costs per day ($3114 vs. $2810, p < 0.001), and lower odds of acute kidney injury (AOR = 0.81, p < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, p < 0.001). There was no difference between the 2 groups’ requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients. Conclusions: Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.
AB - Introduction: Upper gastrointestinal bleeding is common in liver cirrhosis patients. Studies have described the prognostic impact of liver disease in non-variceal upper gastrointestinal bleeding (NVUGIB), but a direct subgroup comparison is lacking using a large database. Aim: To study the impact of NVUGIB on hospital-based outcomes in patients with cirrhosis. Material and methods: This is a retrospective study using Nationwide Inpatient Sample (NIS) employing International Classification of Diseases (ICD-10) codes for adult patients with a primary diagnosis of NVUGIB. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA, proportions were compared using Fisher exact test, and continuous variables using Student’s t-test. Confounding variables were adjusted using propensity matching, multivariate logistic, and linear regression analyses. Results: Of 107,001,355 discharges, 957,719 had a diagnosis of NVUGIB. Of those, 92,439 had cirrhosis upon admission. NVUGIB patients with cirrhosis had higher adjusted odds of mortality and intensive care unit (ICU) admission than patients without cirrhosis (adjusted odds ratio (AOR) for mortality 1.31, p < 0.001, ICU admission AOR = 1.29, p < 0.001). NVUGIB patients with cirrhosis had shorter length of stay (LOS) by 0.44 days (p < 0.001), greater hospital costs per day ($3114 vs. $2810, p < 0.001), and lower odds of acute kidney injury (AOR = 0.81, p < 0.001). In addition, the cirrhotic patients had higher odds of receiving endoscopic therapy (AOR = 1.08, p < 0.001). There was no difference between the 2 groups’ requirements of packed red blood cell transfusion, parenteral nutrition, hypovolaemic shock, and endotracheal intubation. We also identified novel independent predictors of mortality from NVUGIB in cirrhosis patients. Conclusions: Cirrhosis presents greater mortality and morbidity burden and greater healthcare resource utilization from NVUGIB.
KW - esophagogastroduodenoscopy
KW - gastrointestinal haemorrhage
KW - hospital costs
KW - liver cirrhosis
KW - morbidity
KW - mortality
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U2 - 10.5114/pg.2022.115232
DO - 10.5114/pg.2022.115232
M3 - Article
AN - SCOPUS:85142191136
SN - 1895-5770
VL - 18
SP - 204
EP - 215
JO - Przeglad Gastroenterologiczny
JF - Przeglad Gastroenterologiczny
IS - 2
ER -