TRENDS OF VTE AMONG HIV-RELATED HOSPITALIZATIONS IN THE UNITED STATES

Abstract

TOPIC: Pulmonary Vascular Disease TYPE: Original Investigations PURPOSE: Chronic infections such as HIV and increasing age have been independently associated with higher venous thromboembolism (VTE) risk. Given the increasing survival of people living with HIV with the advent of antiretroviral treatment, it is important to examine the current trend of VTE among this unique population. METHODS: We queried the National Inpatient Database (NIS), Healthcare Cost and Utilization Project (HCUP) which is a stratified random representative sample of discharges from all hospitals nationwide except for rehabilitation and long-term acute care hospitals. We then identified all individuals with a diagnosis of HIV as defined by ICD9 codes 042 from 2005-2014. VTE was defined by ICD9 codes 415, 416, 451, and 453. We calculated annual rates of inpatient VTE by patient characteristics (age, sex, and race) and type of VTE. We then performed a logistic regression to assess risk factors for the occurrence of VTE among hospitalized patients with HIV adjusting for significant predictors such as age, race, socioeconomic factors, obesity, diabetes, other medical comorbidities, and length of stay, and in-hospital mortality. Comorbidity burden was captured using the Charleston comorbidity index. RESULTS: From 2005-2014, the NIS contained data on approximately 247,467 weighted (approx 608,387 actual) HIV-related hospitalizations. Among these, about 3% (8,587, approx 18, 668 actual) had a concurrent diagnosis of VTE. In general, there was an overall increasing trend in the prevalence of VTE from 2.45% in 2005 to 4.1% in 2015 (P<0.001). There was a persistently higher prevalence among older age groups, men, and Blacks. Multivariable regression analysis shows the odds of VTE occurrence increased over time (OR 1.04; 95%CI 1.04 -1.05; P<0.001) for each year and was higher among older(OR 1.01; 95%CI 1.00-1.01; P<0.001), Black (OR 1.13; 95%CI 1.07-1.19; P<0.001), obese (OR 1.26; 95%CI 1.12-1.40; P<0.001), and complication with AIDS (OR 1.47; 95%CI 1.40-1.54; P<0.001). Female gender (OR 0.88; 95%CI 0.83-0.92; P<0.001), Hispanic ethnicity (OR 0.91; 95%CI 0.84-0.98; P=0.009) and Asian race (OR 0.65; 95%CI 0.46-0.89; P=0.01) were associated with lower VTE risk. In-hospitality mortality (OR 1.99; 95%CI 1.83-2.15, P<0.001) and longer length of stay (OR 1.03, 95%CI 1.02-1.03; P<0.001) were also associated with a diagnosis of VTE. CONCLUSIONS: The trend of VTE prevalence among HIV-related hospitalizations in the US continues to increase over time. Age, obesity, and Black race were the most significant risk factors for VTE, and VTE was associated with increased mortality. CLINICAL IMPLICATIONS: The increasing incidence of VTE and its resultant burden on the healthcare system require more concerted prevention efforts. DISCLOSURES: No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Dwayne Nelson, source=Web Response No relevant relationships by Daniel Nepaul, source=Web Response No relevant relationships by Kelechi Weze, source=Web Response