E0517 - Outcomes and Complications of Hospitalized Cirrhosis Patients With H. pylori Infection

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Parth Desai, DO

Tower Health - Reading Hospital
Reading, PA

Parth Desai, DO¹, Ameya Deshmukh, DO², Biraj Shrestha, MD¹, Abdul Mohammed, MD³, Nirav Shah, MD¹, John Altomare, MD¹
¹Tower Health - Reading Hospital, Reading, PA; ²Saint Louis University School of Medicine, St. Louis, MO; ³Cleveland Clinic, Cleveland, OH

Introduction: Helicobacter pylori is a frequent cause of chronic gastritis, peptic ulcer disease, and gastric cancer worldwide. In patients with cirrhosis, H. pylori is associated with an increased risk of portal vein thrombosis, hepatocellular carcinoma, and hepatic encephalopathy. This study aims to evaluate the impact of H. pylori on cirrhosis complications and inpatient outcomes in the US population.

Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019 for hospitalizations with a primary diagnosis of cirrhosis. We assessed demographics, in-hospital mortality, and complications of cirrhosis in patients with H. pylori and compared them to cirrhosis patients without H. pylori. We adjusted outcomes for potential confounders using multivariable logistic regression analysis.

Results: Of 416,410 patients with cirrhosis, 990 (0.2%) had a concurrent diagnosis of H. pylori infection. Cirrhosis patients with H. pylori were more likely younger (54.25 vs. 57.18 years, p=0.01), of Hispanic race (36.4% vs. 18.6%, p< 0.1), and of Black race (20.2% vs. 8.1%, p< 0.1). H. pylori patients were more likely in the bottom quartile of median household income (48.17% vs. 34.66%, p< 0.01). H. pylori exposed patients had lower in-hospital mortality (0.51% vs 4.44%, p=0.007), but longer mean length of stay (6.97 days vs 5.75, p=0.002). H. pylori-exposed patients had a higher overall rate of cirrhosis-related complications (84.85% vs. 67.59%, p< 0.001), gastrointestinal bleed (48.48% vs. 27.34%, p< 0.001), and hepatorenal syndrome (70.71% vs. 46.99%, p< 0.001) which persisted on multivariable analysis. Rates of hepatic encephalopathy were initially higher in H. pylori-non-exposed patients (21.57% vs. 15.66%, p=0.04), which was corrected after adjusting potential confounders in multivariable analysis (Figure 1).

Discussion: In this study, H. pylori was associated with a higher length of stay in hospitalized cirrhotic patients but lower mortality. H. pylori patients had increased overall complications driven by gastrointestinal bleeding and hepatorenal syndrome. The lower mortality rate of H. pylori infection may partly be due to antibiotic use. Given the limitations of this retrospective cohort study, H. pylori as a causative factor for cirrhosis complications cannot be inferred with certainty. However, further studies are warranted to help elucidate the associations between H. pylori and cirrhosis complications. Eradicative therapy for H. pylori may be beneficial in select patients with Cirrhosis.

Figure: Odds of Complications in Cirrhosis Patients with H. pylori Infection

Unadjusted and adjusted odds ratios* for overall complications, in-hospital mortality, gastrointestinal bleed, encephalopathy, hepatorenal syndrome and spontaneous bacterial peritonitis (SBP).

*Adjusted for age, race, female, hypertension, diabetes, hyperlipidemia, heart failure, CKD stage 3 or greater, alcohol use disorder, coronary artery disease.

Baseline characteristics	Overall (%) (N= 416,410)	Helicobacter Pylori Absent (%) (N= 415,420)	Helicobacter Pylori Present (%) (N= 990)	P-value
Cirrhosis
Mean Age, (Mean ± Standard error) (Years)	57.17 (57.07 - 57.27)	57.18 (57.08 - 57.28)	54.25 (52.55 - 55.95)	0.001
Age (years)				0.01
18-49	24.73	24.71	33.84
50-64	49.61	49.61	47.47
65-74	17.83	17.84	12.12
>= 75	7.84	7.84	6.57
Gender				0.028
Male	63.13	63.11	70.71
Female	36.87	36.89	29.29
Race				< 0.001
White	64.01	64.10	26.26
Black	8.13	8.10	20.20
Hispanic	18.62	18.58	36.36
Asian or Pacific Islander	1.72	1.71	5.56
Native American	1.50	1.50	2.53
Other	6.02	6.02	9.09
Comorbidity^a
Obesity	14.29	14.30	11.62	0.275
BMI < 20	2.71	2.71	3.54	0.578
Hypertension	49.70	49.71	42.42	0.042
Diabetes	30.10	30.12	24.75	0.108
Hypercholesterolemia	16.33	16.35	8.08	0.002
Heart failure	11.95	11.96	7.58	0.059
Valvular Disease	0.74	0.74	0.51	0.701
CKD stage 3 or more	12.92	12.94	6.06	0.004
Alcohol use disorder	48.56	48.53	61.11	< 0.001
Peripheral vascular disease	3.72	3.73	1.52	0.101
COPD	12.94	12.94	10.61	0.327
Stroke	0.58	0.59	0.00	0.295
CAD	12.19	12.21	7.07	0.028
Cardiomyopathy	2.28	2.28	2.53	0.818
Coagulopathy	0.86	0.86	0.00	0.219
Bleeding Disorder	42.48	42.48	41.92	0.873
Smoking	22.28	22.27	25.25	0.325
Cancer	7.70	7.70	6.06	0.389
Autoimmune Disease	2.06	2.06	1.01	0.298
Median household income category for patient's Zip Code^d				0.0002
0-25 percentile	34.69	34.66	48.17
26-50 percentile	26.73	26.73	24.61
51-75 percentile	22.64	22.64	19.90
76-100 Percentile	15.94	15.96	7.33
Primary Payer^e
Federal insurance	65.68	65.68	65.68
Private insurance	21.86	21.88	12.12
Other	3.22	3.22	5.56
Uninsured	9.06	9.05	15.66
Missing	0.17	0.17	0.00
Hospital characteristics
Hospital region				0.013
Northeast	16.76	16.76	17.17
Midwest	19.27	19.27	19.19
South	43.00	43.02	33.84
West	20.97	20.95	29.80
Hospital bed size^f				0.025
Small	17.11	17.11	13.64
Medium	28.33	28.35	22.22
Large	54.56	54.54	64.14
Hospital teaching status^g				< 0.001
Non-teaching	26.42	26.45	15.15
Teaching	73.58	73.55	84.85
Hospital location				0.066
Rural	5.51	5.52	2.53
Urban	94.49	94.48	97.47
Disposition				< 0.001
Home	63.25	63.21	80.30
Facility/others	4.43	4.44	0.51
Died	32.32	32.35	19.19
Admission Type				0.446
Non-Elective	94.70	94.70	97.47
Elective	5.14	5.14	2.53
Missing	0.16	0.16	0.00
In-hospital mortality	4.43	4.44	0.51	0.007
Length of stay (Mean ± Standard error) (Days)	5.76 (5.68 -5.83)	5.75 (5.68 - 5.83)	6.97 (6.21 – 7.72)	0.002
Cost of care (Mean ± Standard error) (USD)	16547.22 (16031.09 - 17063.36)	16543.49 (16026.53 - 17060.45)	18106.18 (15947.94 - 20264.41)	0.160
Elixhauser Comorbidity Index for Mortality (Mean ± 95% Conf. Interval)^h	-1.86 (-1.91 to -1.81)	-1.86 (-1.91 to -1.81)	-1.77 ( -2.51 to -1.03)	0.809

Disclosures:

Parth Desai indicated no relevant financial relationships.

Ameya Deshmukh indicated no relevant financial relationships.

Biraj Shrestha indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Nirav Shah indicated no relevant financial relationships.

John Altomare indicated no relevant financial relationships.

Parth Desai, DO¹, Ameya Deshmukh, DO², Biraj Shrestha, MD¹, Abdul Mohammed, MD³, Nirav Shah, MD¹, John Altomare, MD¹. E0517 - Outcomes and Complications of Hospitalized Cirrhosis Patients With H. pylori Infection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.