Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study.

Margaret V Ragni,Jonathan G Yabes,Jessica B Cohen,Diane M Comer

doi:10.1055/s-0040-1710506

Abstract

Introduction Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear. Methods We performed a retrospective analysis of discharge data from the National Inpatient Sample between 2009 and 2014, using International Disease Classification codes to identify IBD and non-IBD patients with or without thrombosis. We used NIS-provided discharge-level weights to reflect prevalence estimates. Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression. Results Thrombosis prevalence in IBD was significantly greater than in non-IBD, 7.52 versus 4.54%, p < 0.0001. IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each p < 0.001. Thrombosis occurred most commonly in the mesenteric vein. Thrombotic risk factors in IBD include surgery, ports, malignancy, dehydration, malnutrition, and steroids at 53.7, 13.2, 13.1, 12.4, 8.9, and 8.2%, respectively. Those with thrombosis had greater severity of illness, 1.42 versus 0.96; length of stay, 7.7 versus 5.5 days; and mortality, 3.8 versus 1.5%; all p < 0.0001. Adjusting for age and comorbidity, odds ratios for predictors of thrombosis included ports, steroids, malnutrition, and malignancy at 1.73, 1.61, 1.34, and 1.13, respectively, while Asian race, 0.61, was protective, each p < 0.001. Conclusion Thrombosis prevalence is 1.7-fold greater in IBD than non-IBD patients. Adjusting for age and comorbidity, the odds ratio for thrombosis in IBD was 73% higher with ports, 61% higher with steroids, 34% with malnutrition, and 13% with malignancy. Whether long-term anticoagulation would benefit the latter is unknown.

Highlights

Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear
Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression
IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each p < 0.001

Summary

Introduction

Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear. Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal (GI) mucosa including Crohn’s disease (CD) and ulcerative colitis (UC). An estimated 1.4 million people in the United States currently suffer from IBD, and the incidence is increasing with time.[1,2,3] These disorders are characterized by defective immune regulation in which T-cells in the GI mucosa secrete inflammatory cytokines.[4,5] The subsequent inflammatory response, both acute and chronic, induces a prothrombotic state which is mediated by an increase in procoagulant factors and a decrease in natural anticoagulants and in fibrinolytic activity.[6] there is an upregulation of tissue factor and an received December 20, 2019 accepted April 7, 2020.

Methods

Results

Conclusion