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Thromboembolic Events in Hospitalized Patients with Inflammatory Bowel Disease

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Abstract

Background

Inflammatory bowel disease (IBD) has been associated with an increased risk of thromboembolic vascular complications. Although studies from the National Inpatient Sample (NIS) examined this association to some extent, sub-stratification for Crohn’s disease (CD) and ulcerative colitis (UC) in larger studies is lacking. The aims of this study were to utilize the NIS to determine the prevalence of thromboembolic events in inpatients with IBD compared to in patients without IBD and to explore the inpatient outcomes like morbidity, mortality, and resource utilization in patients with IBD and thromboembolic events as stratified by disease subtype.

Methods

This was a retrospective observational study using the NIS 2016. All patients with ICD10-CM codes for IBD were included. Patients with thromboembolic events were identified using diagnostic ICD codes and stratified into 4 categories: (1) Deep vein thrombosis (DVT), (2) Pulmonary embolism (PE), (3) Portal vein thrombosis (PVT), and (4) Mesenteric ischemia, which were then sub-stratified for CD and UC. The primary outcome was the inpatient prevalence and odds of thromboembolic events in patients with IBD compared to without IBD. Secondary outcomes were inpatient morbidity, mortality, resource utilization, colectomy rates, hospital length of stay (LOS), and total hospital costs and charges compared to patients with IBD and thromboembolic events.

Results

A total of 331,950 patients with IBD were identified, of who 12,719 (3.8%) had an associated thromboembolic event. For the primary outcome, after adjusting for confounders, inpatients with IBD had higher adjusted odds of DVT (aOR 1.59, p < 0.001), PE (aOR 1.20, p < 0.001), PVT (aOR 3.18, p < 0.001) and mesenteric ischemia (aOR 2.49, p < 0.001) compared to inpatients without IBD, an observation which was confirmed for both patients with CD and UC. Inpatients with IBD and associated DVT, PE and mesenteric ischemia had higher morbidity, mortality, odds of colectomy, cost, and charges.

Conclusions

Inpatients with IBD have higher odds of associated thromboembolic disorders compared to patients without IBD. Furthermore, inpatients with IBD and thromboembolic events have significantly higher mortality, morbidity, colectomy rates and resource utilization. For these reasons, increased awareness and specialized strategies for the prevention and management of thromboembolic events should be considered in inpatients with IBD.

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Abbreviations

AKI:

Acute kidney injury

CD:

Crohn’s disease

CI:

Confidence interval

DVT:

Deep venous thrombosis

IBD:

Inflammatory bowel disease

HCUP:

Healthcare Cost and Utilization Project

ICD-CM:

International classification of diseases – Clinical Modification

ICU:

Intensive care unit

LOS:

Length of stay

NIS:

National Inpatient Sample

PE:

Pulmonary embolism

PVT:

Portal vein thrombosis

RR:

Relative risk

TE:

Thromboembolic event

UC:

Ulcerative colitis

VTE:

Venous thromboembolic event

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Authors and Affiliations

  1. Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA

    Alfred D. Nelson, Daniela Fluxá, Francis A. Farraye, Jana G. Hashash & Paul T. Kröner

  2. Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI, USA

    Freddy Caldera

  3. Advent Health Winter Park, 200 N Lakemont Av, Winter Park, 32792, USA

    Alfred D. Nelson

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  1. Alfred D. Nelson
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  2. Daniela Fluxá
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Correspondence to Alfred D. Nelson.

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Conflict of interest

Dr. Freddy Caldera has received research support from Takeda Pharmaceuticals and Sanofi. He has been a consultant for Takeda and Celgene. Dr. Farraye has served on advisory boards for BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, Glaxo Smith Kline, Iterative Health, Janssen, Pfizer and Sebela. Dr. Farraye serves on a data Safety Monitoring Board for Adiso Therapeutics and Lilly.

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Nelson, A.D., Fluxá, D., Caldera, F. et al. Thromboembolic Events in Hospitalized Patients with Inflammatory Bowel Disease. Dig Dis Sci 68, 2597–2603 (2023). https://doi.org/10.1007/s10620-023-07920-6

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  • DOI: https://doi.org/10.1007/s10620-023-07920-6

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