P2802 - Trends Analysis of Inpatient Outcomes of Venous Thromboembolism in Patients with Underlying Nonalcoholic Fatty Liver Disease: A Nationwide Inpatient Sample Analysis

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Yi Jiang, MD

Rutgers New Jersey Medical School
Newark, NJ, United States

Yi Jiang, MD¹, Konstantinos Damiris, DO¹, Salil Chowdhury, MD², Binghong Xu, MD³, Ahmed M. Ahmed, DO¹, Nikolaos Pyrsopoulos, MD, PhD, MBA¹
¹Rutgers New Jersey Medical School, Newark, NJ; ²Thomas Jefferson University Hospital, Newark, NJ; ³RWJBH-Saint Barnabas Medical Center, Livingston, NJ

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide. There have been studies suggesting the increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE) and portal vein thrombosis (PVT) in patients with NAFLD. This study aims to determine the trends in patients hospitalized with VTE and concomitant NAFLD, and the factors associated with outcomes.

Methods: The NIS database was used to identify hospitalized adult patients with VTE and secondary NAFLD from 2010-2014. Primary outcomes included the trend of the prevalence of the comorbid diseases of NAFLD and VTE (including DVT, PE, and PVT) and related outcomes. Secondary outcomes included factors that were independently associated with mortality.

Results: Between 2010 and 2014, there was an uptrend of VTE with NAFLD hospitalizations (8.8 to 13.2 per 100,000 adults, p < 0.0001). These findings were also associated with an increase of PE (60% to 62.5%, p = 0.0005) and PVT (7.3% to 12%, p < 0.001). There was a decrease in DVT (38.5% to 31.8%, p < 0.0001) over the time span. Length of stay (LOS) decreased from 6.7 days to 5.9 days (p = 0.03). After adjusting for covariates, the mortality was significantly higher in those > 50 years old, especially > 70 years old [adjusted odds ratio (aOR) 2.31, p = 0.0003) and males (aOR 1.24, p = 0.048). Mortality was also significantly higher in certain ethnic groups (Asian or Pacific Islander, Native American, aOR 2.02, p = 0.0014) but lower in the African-American group (aOR 0.4, p = 0.0007) when compared with the Caucasian group. Additionally, mortality was greatest in the south (aOR 2.27, p < 0.0001) and west (aOR 1.85, p = 0.0059) when compared to the northeast region. Mortality increased amongst those of lower median household income, and in those with malignancy (p < 0.0001), hepatocellular carcinoma (p < 0.0001), heart failure (p < 0.0001), and pulmonary circulation disorders (p < 0.0001). Interestingly, we found neither cirrhosis nor the type of VTE was a predictor for worse hospital mortality.

Discussion: Between 2010 and 2014, there was an uptrend in the overall prevalence of VTE in patients hospitalized with NAFLD, while LOS decreased, and mortality remained unchanged. Further analysis identified ethnic and socioeconomic disparities significantly affecting mortality. Continued prospective studies are needed in order to evaluate the pathophysiology and social impacts of at-risk individuals and their effects on outcomes.

Figure: Figure 1. Trend in the percent of thrombosis conditions in patients hospitalized for venous thromboembolism and comorbid nonalcoholic fatty liver disease. PE = pulmonary embolism; DVT = deep vein thrombosis (low extremities); PVT = portal vein thrombosis.

	Unadjusted Model		Adjusted Model
	Odds ratio (95% CI)	p-value	Odds ratio (95% CI)	p-value
Age
18-39	1	REF	1	REF
40-49	1.25 (0.76,2.06)	0.38	1.16 (0.69,1.92)	0.57
50-59	1.98 (1.26,3.1)	0.0028	1.61 (1.02,2.55)	0.041
60-69	2.58 (1.66,3.99)	< .0001	1.94 (1.24,3.05)	0.0039
70+	3.28 (2.12,5.07)	< .0001	2.31 (1.47,3.62)	0.00026
Sex
Male	1.06 (0.87,1.31)	0.54	1.24 (1,1.53)	0.048
Female	1	REF	1	REF
Race
White	1	REF	1	REF
Black	0.39 (0.23,0.65)	0.00035	0.4 (0.24,0.68)	0.00073
Hispanic	1.19 (0.85,1.66)	0.31	1.23 (0.86,1.75)	0.24
Other	1.74 (1.15,2.64)	0.0093	2.02 (1.31,3.12)	0.0014
Hospital region
Northeast	1	REF	1	REF
Midwest	1.57 (1.02,2.42)	0.039	1.46 (0.94,2.27)	0.095
South	2.46 (1.67,3.62)	< .0001	2.27 (1.53,3.36)	< .0001
West	1.94 (1.27,2.98)	0.0022	1.85 (1.19,2.86)	0.0059
Median household income for patient's ZIP Code, %
Q1	3.66 (2.36,5.67)	< .0001	3.59 (2.29,5.61)	< .0001
Q2	4.22 (2.74,6.5)	< .0001	4.26 (2.75,6.61)	< .0001
Q3	4.03 (2.6,6.24)	< .0001	4.57 (2.94,7.13)	< .0001
Q4	1	REF	1	REF
Hepatocellular carcinoma	5.82 (3.38,10.01)	< .0001	3.33 (1.83,6.05)	< .0001
Malignancy	3.84 (3.02,4.87)	< .0001	3.47 (2.68,4.5)	< .0001
Heart failure	3.49 (2.74,4.44)	< .0001	2.74 (2.12,3.55)	< .0001
Pulmonary circulation disorders	3.35 (2.73,4.12)	< .0001	3.11 (2.51,3.86)	< .0001

Table: Table 1. Association of patient and hospital characteristics on mortality outcomes of individuals hospitalized for venous thromboembolism and comorbid nonalcoholic fatty liver disease.
REF = reference; Median household income for patient's ZIP Code (based on current year): Q1 = 0-25th percentile; Q2 = 26th to 50th percentile; Q3 = 51st to 75th percentile; Q4 = 76th to 100th percentile

Disclosures:

Yi Jiang indicated no relevant financial relationships.

Konstantinos Damiris indicated no relevant financial relationships.

Salil Chowdhury indicated no relevant financial relationships.

Binghong Xu indicated no relevant financial relationships.

Ahmed Ahmed indicated no relevant financial relationships.

Nikolaos Pyrsopoulos indicated no relevant financial relationships.

Yi Jiang, MD¹, Konstantinos Damiris, DO¹, Salil Chowdhury, MD², Binghong Xu, MD³, Ahmed M. Ahmed, DO¹, Nikolaos Pyrsopoulos, MD, PhD, MBA¹. P2802 - Trends Analysis of Inpatient Outcomes of Venous Thromboembolism in Patients with Underlying Nonalcoholic Fatty Liver Disease: A Nationwide Inpatient Sample Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.