Introduction: While Aortic stenosis (AS) is associated with gastrointestinal arteriovenous malformations, it’s association with Gastric Antral Vascular Ectasia (GAVE), as a rare cause of upper gastrointestinal bleeding (UGIB), remain unknown. Therefore, authors aim to investigate outcomes of hospitalized GAVE patients in the setting of AS, in terms of mortality and in-hospital complications.
Methods: Using International Classification of Diseases Tenth Revision (ICD-10) codes, the National Inpatient Sample database of the years 2016 through 2019 was searched for patients admitted with a primary diagnosis of GAVE, with and without history of AS. Univariate and Multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications in GAVE/AS group compared to GAVE-only group. Patients and facilities characteristics, as well as comorbidities, were incorporated into the analysis.
Results: Among 85,090 adults’ patients were hospitalized with a primary diagnosis of GAVE from 2016 - 2019, 5315 (6.2%) had a secondary diagnosis of AS. Patients baseline characteristics are listed in Table 1. Patients with AS had a 2-folds increase in risk of GAVE (OR 2.08, 95% CI 1.94 – 2.22, p< 0.001), with no difference in inpatient mortality between the study groups (OR 1.36, 95% CI 0.78 – 2.36, p=0.268). GAVE-AS patients had higher risk of hypovolemic shock (OR 2.00, 95% CI 1.34 – 2.97, p= 0.001), acute coronary syndromes (OR 2.25, 95% CI 1.76 – 2.88, p< 0.001) with no difference in risk of cardiogenic shock (OR 1.35, 95% CI 0.29 – 6.25, p= 0.695), acute kidney injury (OR 0.95, 95% CI 0.82 – 1.11, p= 0.550), blood transfusion (OR 1.07, 95% CI 0.94 – 1.22, p= 0.270), sepsis (OR 0.86, 95% CI 0.49 – 1.51, p= 0.598), ischemic stroke (OR 1.00, 95% CI 0.76 – 1.32, p=0.981), respiratory failure (OR 1.21, 95% CI 0.90 – 1.65, p= 0.200) or in-hospital cardiac arrest (OR 1.29, 95% CI 0.44 – 3.79, p= 0.638). Cost of care in GAVE-AS patients was increased by a mean of 4729$ (95% CI 694– 8764, p= 0.022), with no increase in length of stay (95% CI -0.13 – 0.42, p=0.320) when compared to GAVE-only patients.
Discussion: Our study is a first to demonstrate that patients with history of AS have 2-fold increase in risk of development of GAVE. Admitted GAVE-AS patients are at increased risk of hypovolemic shock, acute coronary syndrome and higher resources utilization when compared to GAVE-only patients.
.jpg "Mohammad Aldiabat, MBBS photo")