C0176 - Assessment of Mortality Among Patients Having Colorectal Cancer and Atrial Fibrillation

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Xiaoliang Wang, MD, PhD

Marshall University Joan C. Edwards School of Medicine
Huntington, WV

Xiaoliang Wang, MD, PhD¹, Ebad Rahman, MD², Ali Wakil, MD³, Tejas Joshi, MD¹, Shima Ghavimi, MD⁴
¹Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ²SMMC, Huntington, WV; ³Rutgers New Jersey Medical School, Newark, NJ; ⁴Marshall University, Ona, WV

Introduction: Atrial Fibrillation (AFib) is the most common persistent cardiac arrhythmia, occurring in about 1% of the general population and Colorectal cancer (CRC) is the fourth most diagnosed cancer in the world. Although, there is well-established literature assessing the relationship of patients with cancer and AFib, very few studies have depicted the relationship between CRC and AFib. Our study aims to assess the effect of AFib on the mortality among CRC patients.

Methods: In this retrospective analysis, National Inpatient Sample (NIS) data from 10/2015 to 12/2017 was used which include 245,305 patients in this study. Demographic characteristics and clinical outcomes were compared among patients diagnosed with CRC with and without AFib. Bivariate analyses were performed using the chi-squared test or Fisher exact test (2-tailed) for categorical variables as appropriate, to assess the differences in the two groups.

Results: Patients who had CRC and AFib had 1.71 (95% CI: 1.45-2.02) higher odds of mortality compared with those without AFib. After propensity match of demographics and clinical factors, there was still 1.44 (95%CI: 1.18-1.75) times higher probability of mortality in AFib patient. Additionally, CRC with AFib had significantly prolonged hospitalization and cost. Secondary outcome analysis showed that AFib associate with high odds of sepsis (OR: 1.45, 95%CI: 1.30-1.62), AKI (OR: 1.45, 95%CI: 1.30-1.62), lower GI bleeding (OR: 1.31, 95%CI: 1.21-1.43) and respiratory failure (OR: 1.39, 95%CI: 1.15-1.67)) after the propensity match (Table 1). Interestingly, females had 25% lower odds of predictive mortality compared with males who were diagnosed with colorectal cancer and AFib (95%CI: 0.58-0.97) In addition, subjects who had CCI of 2 had 65% lower odds of mortality (95%CI: 0.22-0.55) comparing with CCI of 3 or more (Table 1).

Discussion: Several studies have demonstrated that AFib is more common among CRC patient. With growing cancer burden and the high incident of AFib, it becomes important to study the effect of AFib on CRC mortality. As we found here, that AFib associate with 1.4 time higher odds of mortality in CRC patients after propensity match. Interestingly, higher odds of other complications such as sepsis, AKI, Respiratory failture and GI bleeding was also found in CRC patients with AFib, which could be the cause of higher mortality rate in AFib patient. Therefore, AFib could become a good indicator for the mortality in CRC patient.

Variable	OR of primary and secondary outcome in CRC without vs with AFib after Propensity matched
Variable	OR (95% CI)	p Value
Mortality	1.44 (1.18-1.75)	< 0.001
Sepsis	1.45(1.30-1.62)	< 0.001
Mechanical Ventilation	1.38(1.11-1.72)	0.004
AKI	1.45(1.30-1.62)	< 0.001
Respiratory Failure	1.39(1.15-1.67)	< 0.001
Blood transfusion	1.61(1.05-1.29)	0.005
Lower GI bleeding	1.31(1.21-1.43)	< 0.001
Pressure support	1.96(1.18-3.26)	0.01

Predictors	Predictors of mortality in CRC with AFib
Predictors	OR (95% CI)	p Value
Female	0.75(0.58-0.97)	0.028
Race (Black)	1.04(0.63-1.73)	0.868
Race (Hispanic)	1.37(0.80-2.35)	0.245
Race (Asian)	0.66(0.20-2.18)	0.501
CCI of 2	0.35(0.22-0.55)	0.001

Table: Table 1 (upper) Propensity matched analysis showing effect of AFib on mortality in CRC patient. (Lower) Predictors of mortality in CRC with AFib. OR, Odds ratio; CRC, Colorectal cancer; AKI, Acute kidney injury; CCI, Charlson comorbidity index.

Disclosures:

Xiaoliang Wang indicated no relevant financial relationships.

Ebad Rahman indicated no relevant financial relationships.

Ali Wakil indicated no relevant financial relationships.

Tejas Joshi indicated no relevant financial relationships.

Shima Ghavimi indicated no relevant financial relationships.

Xiaoliang Wang, MD, PhD¹, Ebad Rahman, MD², Ali Wakil, MD³, Tejas Joshi, MD¹, Shima Ghavimi, MD⁴. C0176 - Assessment of Mortality Among Patients Having Colorectal Cancer and Atrial Fibrillation, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.