LIVER CIRRHOSIS CONFERS WORSE OUTCOMES IN PULMONARY EMBOLISM PATIENTS

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Pulmonary embolism (PE) entails a huge health burden in the U.S. The impact of cirrhosis on clinical outcomes in patients with pulmonary embolism is not well described. METHODS: We searched for patients age ≥18-years-old with hospital admissions in the year 2012-2014 with a principal diagnosis of PE. The study population was then divided into two groups based on the presence or absence of cirrhosis (ICD-9-CM code 571.2, 571.5, 571.6). ICD codes were used to identify common comorbidities including congestive heart failure, history of myocardial infarction and atrial fibrillation. We used both propensity score matching and multivariable regression modeling to evaluate in-hospital mortality, length of stay, comorbidities, and in-hospital complications. RESULTS: The prevalence of cirrhosis among the 200,850 PE patients was 0.71%. In both the propensity score matching model and the multivariate regression model, in-hospital mortality was higher in patients with cirrhosis (8.39 % vs 3.41 %, P<0.001). Length of hospital stay for patients with PE was also higher amongst patients with cirrhosis (6.8 days vs. 5.0 days, P<0.001). Massive PE was significantly more prevalent in the cirrhosis group (10.45% vs. 4.94%, p<0.001). PE and cirrhosis synergistically conferred a higher risk of in-hospital complications including cardiac arrest (4.18 % vs. 1.84 %, p=0.003), mechanical ventilation (8.36% vs. 4.06 %, p=0.0003), cardiogenic shock (2.09 % vs. 0.91 %, p=0.0393), blood transfusion (8.71 % vs. 4.2 %, p=0.001), platelet transfusion (2.79 % vs. 0.28 %, p<0.001) and non-home discharge (50.52 % vs. 35.94 %, p<0.001). No significant difference in the incidence of sepsis was found between two groups (3.48 % vs. 1.46 %, p>0.05). CONCLUSIONS: In both the propensity score matching and multivariate regression models, PE and cirrhosis synergistically conferred a higher risk of mortality and longer length of stay. Massive PE had a higher incidence in the cirrhosis group, likely related to hypercoagulability in cirrhosis. Cirrhosis was also associated with significantly higher rates of cardiac arrest, mechanical ventilation, cardiogenic shock, blood and platelet transfusion, and non-home discharge. CLINICAL IMPLICATIONS: Massive PE has a higher incidence in the cirrhosis group, likely related to the hypercoagulable state in cirrhosis. PE and cirrhosis synergistically conferred a higher risk of mortality and longer length of stay and worse clinical outcomes, suggesting that more aggressive workup and treatment may be beneficial. DISCLOSURES: No relevant relationships by Deborah Akanya, source=Web Response No relevant relationships by Sonali Gupta, source=Web Response no disclosure on file for Baoqiong Liu; No relevant relationships by Joseph Mattana, source=Web Response no disclosure on file for Soumya Thumma; No relevant relationships by Yifeng Yang, source=Web Response