Abstract
Abstract BACKGROUND Inflammatory Bowel Disease (IBD) can have numerous complications involving all systems of the body. There are limited data investigating the effect of renal disease on outcomes in patients with IBD . The aim of our study was to examine the impact of End-Stage Renal Disease (ESRD) on the outcomes of patients with IBD. METHODS The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD and ESRD were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. RESULTS We identified 226,264 patients with IBD of which 44,340 patients were matched to those with diagnoses of ESRD. Average age was 60.4 years. There was a significant increase in inpatient mortality (OR 2.22, CI 1.629486-3.018497, p<0.0001), total cost of hospitalization ($31,461.41, CI 21,365.89 - 41,556.94, p<0.0001), and hospital length of stay (2.03 days, CI 1.392255-2.674399, p<0.0001) in patients with IBD with a concurrent diagnosis of ESRD when compared to IBD patients without ESRD. On multivariate analysis, positive predictors of mortality were sepsis (OR: 6.828519 p-value: <0.001; 95% CI: 5.809829 8.025826), aspiration events,(OR: 3.78247 p-value: <0.001; 95% CI: 2.939117- 4.867815), and malnourishment (OR: 2.919507 p-value: <0.001; 95% CI: 2.447496- 3.482547). LOS was increased in patients with hospitalizations complicated by sepsis (OR 3.282481; p-value: <0.001; 95% CI: 2.96-3.60), malnutrition (OR 5.60; p-value: <0.001; CI: 5.11- 6.08), and aspiration events (OR 3.58; p-value:<0.001;CI: 2.74-4.42). Total hospital charges were increased in patients with hospitalizations complicated by sepsis ( $45,351.03; p-value: <0.001; 95% CI: 39,370.62-51,331.44), malnutrition ($63,326.1; p-value: <0.001; CI: 52,921.92-73,730.27), and aspiration events($ 57,778.34; p-value: <0.001; CI: 40,777.18-74,779.5). CONCLUSIONS Our study demonstrates the presence of ESRD in hospitalized patients with IBD is associated with poor outcomes in terms of mortality, length of stay, and total hospital charges. Furthermore concurrent aspiration events, malnutrition, and sepsis are also associated with worsened outcomes. Our study is novel because there are minimal data that investigate the clinical outcomes associated with IBD patients with ESRD. Our study demonstrates that the presence of ESRD poses a significant mortality risk in these patients, among other factors.
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