Abstract
Purpose: To assess the association between mortality and demographic, comorbidities, and inpatient intervention among patients with hemorrhagic intestinal angioectasia. Methods: Using the National Inpatient Sample data between 2000 and 2009, logistic regression (univariate and multivariate) analysis were conducted to assess the association of the following variables on mortality. Demographic covariates included age, race/ethnicity, income, and gender. Comorbidities included the presence of hypovolemia, congestive heart failure (CHF), aortic stenosis (AS), valvular insufficiencies (VI), acute renal failure (ARF), chronic kidney disease (CKD), COPD, and von Willebrand disease. The Charlson-Deyo Index (CDI) and interventions such as packed red cell transfusion (PCT), endoscopy, surgical resection, hemodialysis (HD), central venous catheterization (CVC), and mechanical ventilation (MV) were included in the analysis. Results: We identified 32,238 patients with a primary diagnosis of IA. Multiple logistic regression modeling showed that significant mortality is associated with age range 75-84 years (odds ratio [OR] 1.93) age >85 years (OR 2.96). CDI score range 3-4 (OR 1.64) and CDI score >5 (OR 2.88). Increased mortality is seen with ARF (OR 2.72), CHF (OR 1.33), AS (OR 2.85), VI (OR 3.74), hypovolemia (OR 1.85), and coagulopathies (OR 2.25). Interventions such as HD (OR 1.88), CVC (OR 2.64), MV (OR 19.1), and surgical resections (small bowel OR 1.34, colon OR 3.6, and combined OR 8.28) were associated with increased mortality. The patients who received endoscopy (small bowel, colonoscopy, or both) had lower mortality when compared with those who did not receive endoscopy (OR 0.68, OR 0.50, and OR 0.40, respectively). This trend was also realized among patients who received PCT (OR 0.71). Conclusion: This is the first study to show risk factors for mortality in hospitalized patients diagnosed with IA and blood loss. This study also showed that patients with AS and IA were at increased risk for mortality. Other factors for increased mortality in IA include advanced age, male gender, increased CDI score, ARF, CHF, coagulopathies, and hypovolemia. This trend was also noted in patients who had HD, CVC placement, mechanical ventilation, and surgical resection. Protective factors included PCT and inpatient endoscopy.Figure: Graph of univariate odds ratio of variables associated with mortality.
Published Version
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