Sickle Cell Disease Is Associated With Higher Mortality Among Patients Hospitalized With Ischemic Bowel Disease

Abstract

Introduction: Sickle Cell Disease (SCD) is the most common inheritable hematologic disorder in the United States and is associated with ischemic organ diseases. SCD-associated Ischemic Bowel Disease is being increasingly recognized, but studies on the hospitalization outcomes of such patients is limited. We compared the inpatient outcomes of Ischemic Bowel Disease among patients with SCD compared with patients without SCD. Methods: This is a case-control study using data from the National Inpatient Sample Database (2007-2014). We analyzed and compared outcomes between cases (Ischemic Bowel Disease with SCD) and controls (Ischemic Bowel Disease without SCD), matched in a ratio 1:5. The primary outcome was inhospital mortality, and secondary outcomes were health-care resource utilization including mechanical ventilation, hemodialysis, transfusion, length of stay and hospital charges. Results: Of the 194,262 patients admitted with Ischemic Bowel Disease, 98 had a diagnosis of SCA and were successfully matched to controls. In multivariate analysis, patients with SCD had twice the mortality of those without (aOR = 2.06, 95% CI 1.13-3.74). They were more likely to need mechanical ventilation, blood transfusion and to be discharged to secondary health facilities (1.68[1.02-2.76], 3.32[2.15-5.12] & 1.84[1.02-3.35]). Patients with SCD also had a higher frequency of pneumonia, acute respiratory failure, and hemodialysis for acute renal failure. There was no significant difference in length of stay or total hospital charge between the two groups. Conclusion: In patients hospitalized with Ischemic Bowel Disease, SCD is associated with significantly increased mortality and healthcare burden.172_A Figure 1. Flow chart of how sample was selected from the HCUP-NIS dataset172_B Figure 2. Adjusted odds ratio for mortality and other outcomes