Pedro Palacios, MD1, Bashar M. Attar, MD, PhD2, Chimezie Mbachi, MD1, Ezekiel Chukwujindu, MD3, Isaac Paintsil, MBChB, MPH1, Chineme Nwaichi, MD1, Ishaan Vohra, MD1, Muhammad Majeed, MD1, Yuchen Wang, MD2, Seema Gandhi, MD4
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Cook County Health and Hospital Systems, Chicago, IL; 3University of Nigeria, Nsukka, Enugu, Nigeria; 4Rush University Medical Center, Chicago, IL
Introduction: Inflammatory bowel disease (IBD) is an idiopathic inflammatory process affecting the gastrointestinal tract. Patients with IBD have been shown in several studies to be at higher risk of venous thromboembolism (VTE) and colorectal cancer (CRC) compared to the general population. IBD and CRC have different prothrombotic properties; it is unknown how the interaction of these prothrombotic properties in patients with both IBD and CRC predicts the development of VTE in hospitalized patients necessitating the current study
Methods: The national inpatient sample (NIS) from 2005-2014 was queried for all patients with a co-diagnosis of IBD and CRC who were hospitalized with a diagnosis of VTE as one of the top three discharge diagnosis using ICD9 codes 4534.X, 4533.X, 4511.X, 4518.X, 4151.X, 4538.X and 4151.X. The main outcome was the predictors of VTE. While secondary outcomes were trend in prevalence, length of stay, total charge and in-patient mortality among patients with VTE. All analysis was done using STATAv14.
Results: 7,585 adults with a co-diagnosis of IBD and CRC were included, among which 197 (2.5%) were coded to have VTE as one of their top three diagnoses. Multivariate logistic regression showed that black race patients (10.6% vs 5.2%; aOR 2.33 [1.40-3.89], p=0.001), patients with metastasis (27.9% vs 16.7%; aOR 1.67 [1.17-2.40], p=0.005) and with pulmonary circulation disorders (27.4% vs 1.2%) aOR 28.52 [18.8-43.1], p=< 0.001) had more odds of having VTE while patients with uncomplicated diabetes (8.1% vs 15.5%; aOR 0.47 [0.26-0.84], p=0.012) had less odds of having VTE. Obesity and anemia were significantly associated with VTE in univariate logistic regression analysis but lost its significance on multivariate logistic regression analysis. VTE was also associated with more length of stay (8.41 vs 6.87 days, p=0.005) and more total charges ($64,388 vs $50,874, p=0.009). There was no significant trend in the prevalence of VTE neither was VTE associated with a higher odds of mortality.
Discussion: VTE was more common in patients with metastatic cancer and pulmonary circulation disorders compared to patients with localized disease while obesity and anemia lost significance after multivariate logistic regression analysis. Patients with IBD and CRC might have peculiar procoagulant properties different from patients with only IBD or CRC and might require tailored strategies to stratify these population into a different category so as to develop more directed VTE prophylaxis regimen.
Citation: Pedro Palacios, MD; Bashar M. Attar, MD, PhD; Chimezie Mbachi, MD; Ezekiel Chukwujindu, MD; Isaac Paintsil, MBChB, MPH; Chineme Nwaichi, MD; Ishaan Vohra, MD; Muhammad Majeed, MD; Yuchen Wang, MD; Seema Gandhi, MD. P1411 - PREDICTORS AND TRENDS IN HOSPITALIZED PATIENTS WITH INFLAMMATORY BOWEL DISEASE AND COLORECTAL CANCER THAT DEVELOP VENOUS THROMBOEMBOLISM: A RETROSPECTIVE REVIEW. Program No. P1411. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.