P2610 - Concomitant Autoimmune Hepatitis and Ulcerative Colitis: A Nationwide Inpatient Sample Analysis of Clinical Outcomes and Inpatient Mortality Among Hospitalized Patients

Tanuj R. Chokshi, DO¹, Ahmed M. Ahmed, DO², Benjamin Silver, MD³, Jessica Celenza-Salvatore, DO⁴, Bhesh R. Karki, MD⁵, Fariha Chowdhury, BS⁶, Isabel McFarlane, MD^5
1State University of New York Downstate University Hospital, Brooklyn, NY; ²Rutgers New Jersey Medical School, Newark, NJ; ³State University of New York Downstate, Brooklyn, NY; ⁴State University of New York Downstate Medical Center, Brooklyn, NY; ⁵SUNY Downstate Health Sciences University, Brooklyn, NY; ⁶St. George's University School of Medicine, Brooklyn, NY

Introduction: Autoimmune hepatitis (AIH) is an inflammatory disease process of the liver identified by many clinical features and laboratory markers such as circulating autoantibodies and elevated serum globulin. Ulcerative colitis (UC) is an autoimmune disease of the colon associated with a chronic inflammatory state and extraintestinal manifestations. Although an association between AIH and autoimmune diseases is known, the literature is scarce with regards to outcomes and complications of concomitant AIH and UC in patients. This study aims to evaluate the effects of concomitant UC on AIH.

Methods: The NIS database was used to assess AIH-related hospitalizations from 2012 to 2014 using ICD-9 codes. Patients were split into 2 groups: AIH with and without UC. Primary outcomes were mortality, length of stay (LOS), and cost of hospitalization. Secondary outcomes were complications associated with AIH and include: cirrhosis, gastrointestinal (GI) bleeding, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), hepatocellular carcinoma (HCC), cholangitis, pancreatitis, and sepsis. The results were compared with Chi-squared tests (categorical data) and the independent T-test (continuous data). Multivariate analysis was done to assess primary outcomes after adjusting for confounding variables.

Results: There were 17,040 AIH-related hospitalizations from 2012-2014, of which 360 patients (mean age 38.4, female 61%) had UC. The UC group had a higher cost of hospitalization, lower mortality rate, and lower Charlson Comorbidity Index compared to the AIH only group. With regards to secondary outcomes, the UC group had higher pancreatitis, cholangitis, and liver transplant rates but lower HE rates. No differences in complications like sepsis, GI bleeding, cholangitis, HCC, and SBP were found.

Discussion: Although pancreatitis, cholangitis, and transplant rates were higher in AIH associated with UC, the mortality rate was lower. We postulate these findings derive from the use of immunosuppression in UC, which also targets the autoreactivity cascade of AIH. Immunosuppressors may provide the benefit of better disease control leading to mortality benefit at the cost of an increased risk of complications including infections, such as cholangitis. The identification of the effects of UC on AIH warrants future studies to analyze these associations.



Disclosures:


Tanuj R. Chokshi, DO¹, Ahmed M. Ahmed, DO², Benjamin Silver, MD³, Jessica Celenza-Salvatore, DO⁴, Bhesh R. Karki, MD⁵, Fariha Chowdhury, BS⁶, Isabel McFarlane, MD⁵. P2610 - Concomitant Autoimmune Hepatitis and Ulcerative Colitis: A Nationwide Inpatient Sample Analysis of Clinical Outcomes and Inpatient Mortality Among Hospitalized Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.