Mo1254 Reduction in Colectomy- and Health Care-Related Costs in Ulcerative Colitis Patients Treated With Adalimumab Compared With Standard Therapy

Abstract

Background: There is little information on the frequency of chronic liver disease among hospitalized patients with Inflammatory Bowel Disease (IBD). In this study, we seek to define common etiologies contributing chronic liver disease among IBD patients and identifying potential risk factors predictive of increased mortality in this population. Methods: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. A multivariate analysis was performed to identify factors predictive of increased inpatient mortality. Results: From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has nearly tripled from 0.75 per 100,000 persons in 19882001 to 2.15 per 100, 000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among Ulcerative Colitis patients were: primary sclerosing cholangitis (50.62%), cryptogenic cirrhosis (20.17%), non-alcoholic fatty liver disease (12.73%), chronic hepatitis C (11.00%), primary biliary cirrhosis (4.15%), and chronic hepatitis B (1.33%). In contrast, the most common etiologies contributing to chronic liver disease in Crohn's patients were: primary sclerosing cholangitis (26.54%), chronic hepatitis C (23.99%), cryptogenic cirrhosis (23.99%), non-alcoholic fatty liver disease 20.26%), chronic hepatitis B (3.05%), and primary biliary cirrhosis (2.17%). Compared to IBD patients without concomitant liver disease, there was a 2.5-fold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.76% vs. 1.29%, p ,0.01). The multivariate analysis showed that factors predictive of inpatient mortality among IBD patients with liver disease include— age .50 (OR 1.83 95% CI 1.44, 2.34), spontaneous bacterial peritonitis (OR 2.93 95% CI 2.24, 3.83), hepatic encephalopathy (OR 3.77, 2.75, 5.16), presence of cirrhosis (1.93 OR 95% CI 1.51, 2.48), and Clostridium difficile colitis (OR 2.36 95% 1.29, 4.32). Geographic location, hospital size, and variceal hemorrhage were not predictive of increased mortality. Conclusions: The age-adjusted rate of chronic liver disease among hospitalized IBD patients has nearly tripled since 1988. There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease. Factors predictive of increased morality include older age, Clostridium difficile infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and the presence of cirrhosis. Therefore, early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity.