Elizabeth Brindise, DO, Matthew Kobeszko, MD, Aneesh Kuruvilla, DO, Imad Elkhatib, MD, Rogelio Silva, MD
University of Illinois - Advocate Christ Medical Center, Oak Lawn, IL
Introduction: End Stage Renal Disease (ESRD) is steadily increasing in prevalence in the United States with more than 2 million individuals affected in 2015. ESRD is believed to predispose individuals for gastrointestinal (GI) bleeding by increasing bleeding diatheses, use of heparin during dialysis and GI angiodysplastic lesions. We sought to evaluate outcomes of patients with ESRD and GI bleeding.
Methods: The study population was derived from the HCUP-National Inpatient Sampling (NIS) database for the years 2010 to the third quarter of 2015. ICD-9 codes were used to identify patients with GI bleeding and a history of ESRD. In-hospital all-cause mortality, total cost of hospitalization, mean length of stay and outcome rates were assessed. Propensity score matching was used to adjust for baseline confounders.
Results: Among 5,434,241 admissions with ESRD, 250,383 (4.6%) individuals developed GI bleeding during our study period. 44.2% were female. Patients with ESRD and GI bleeding were more likely to have CAD, coagulation/hemorrhagic disorders, hepatitis, liver and biliary disease and alcohol related disorder (Table 1). GI bleeding in the ESRD population was associated with significantly higher all-cause mortality (10.9% vs 4.7%, P< 0.0001), length of stay (10.5 ± 15.4 vs 6.7 ± 9.3, P< 0.0001), cost of hospitalization ($110,019 ± 207,049 vs $65,875 ± 110,995, P< 0.0001) and blood transfusion rates (16.8% vs 51.2%, P< 0.0001). Furthermore, the GI bleeding cohort required significantly more endoscopies, colonoscopies, and upper and lower GI surgical procedures (Table 2). Following propensity score matching, these statistically significant differences persisted.
Discussion: GI bleeding in patient with co-morbid ESRD is associated with significantly higher all-cause mortality, length of stay, total cost of hospitalization, blood transfusion rates as well as a number of procedures including: endoscopy, colonoscopy, and upper and lower GI surgery.
Citation: Elizabeth Brindise, DO, Matthew Kobeszko, MD, Aneesh Kuruvilla, DO, Imad Elkhatib, MD, Rogelio Silva, MD. P1306 - GASTROINTESTINAL BLEEDING IN PATIENTS WITH CO-MORBID END-STAGE RENAL DISEASE. Program No. P1306. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.