D0492 - Patient Characteristics and In-Hospital Outcomes of Nonalcoholic Steatohepatitis in Patients With Stroke: A Propensity-Matched Analysis

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Devina Adalja, MD

St. Joseph's Regional Medical Center
Paterson, NJ

Devina Adalja, MD¹, Kirtenkumar Patel, MD², Himanshu Kavani, MD³, Zeeshan Tirmizi, MD³, Abdalrahman Assaassa, MD³, Krunalkumar Patel, MD³, Umang Patel, DO³
¹St. Joseph's Regional Medical Center, Paterson, NJ; ²St. Mary Medical Center, Fairless Hills, PA; ³St. Mary Medical Center, Langhorne, PA

Introduction: Nonalcoholic steatohepatitis (NASH) is the commonest chronic liver disease which affects a large group of general population. NASH appears to increase risk of ischemic stroke, a leading cause of mortality and disability world-wide. Moreover, emerging data shows that patient with NASH experience more sever ischemic stroke and have more unfavorable outcomes after an acute ischemic stroke.

Methods: Adult patients admitted with NASH, with and without Stroke were analyzed from September 2015 to December 2020 using the National Inpatient Sample database. We used propensity score matching to balance the differences in baseline characteristics and comorbidities between the two groups. The primary outcome was to determine the burden of stroke in NASH hospitalization. Secondary outcomes included all-cause in-hospital mortality, length of stay (LOS), and total hospital costs. SAS 9.4 software was used for statistical analysis.

Results: Out of 435845 patients admitted with NASH, 3645(0.84%) had concurrent stroke. Stroke cohort consists of patients who are older in age (66.2 ± 11.7 vs. 61.8 ± 13.2 yrs.), with bimodal age variation (41-60yr-25.8% and >80yrs-10.4%) and predominantly female (61.7% vs. 38.3%) compared to those without stroke (P < 0.001). Comorbidities like hypertension, coronary artery disease, obesity, diabetes, peripheral vascular disease, A fib were higher in the stroke group compared to other. Propensity matching showed higher in hospital mortality (9.1% vs. 2.9%, P < 0.001) in patients with NASH and concurrent stroke. Patients with Stroke have a higher inpatient hospital stay [7.6 ± 9.1 vs. 6.1 ± 6.9 days, p < 0.001]. We noted the cost of hospitalization is significantly higher [25728$ ± 43929 vs. 17221$ ± 31454,P < 0.001] in the patient with stroke. Furthermore, our study showed increase need for acute/subacute rehab facility upon discharge (42.9% vs 17.3%) in patient with stroke.

Discussion: Our study suggested that incidence of stroke is higher in Caucasians and females with NASH. In hospital mortality noted to be higher in patients with NASH who suffered from stroke. It also showed a higher cost burden, higher LOS and increase requirement of inpatient rehab post-hospital discharge among patients with NASH and concurrent stroke. Thus, it is important to manage patients with NASH more aggressively to prevent stroke. More studies need to be done in this field to establish whether management of NASH will reduce the risk and improve the outcome of stroke.

Variables	*NASH with Stroke N= 3,645(0.84%)**	NASH without Stroke N= 432,200(99.16%)	P- Value
*Age, in years (Mean ± SD)**	66.2 ± 11.7	61.8 ± 13.2	< 0.001
Age groups, %			< 0.001
18 - 40 years	2.7%	7.3%
41 – 60 years	25.8%	33.1%
61 – 80 years	61%	54.1%
>80 years	10.4%	5.5%
Gender, %			0.7
Male	38.3%	38%
Female	61.7%	61.9%
Race, %			< 0.001
Caucasians	76.1%	74.7%
African Americans	5.6%	4.2%
Others	18.2%	21.1%
Comorbidities, %
Hypertension	77.4%	62.4%	< 0.001
Diabetes mellitus	68.2%	61.3%	< 0.001
Congestive heart failure	25.5%	22.1%	< 0.001
CAD*	33.3%	23%	< 0.001
Peripheral vascular disease	8.5%	4.5%	< 0.001
COPD*	20.2%	22.2%	0.002
Renal failure	25.1%	27.3%	0.002
Coagulopathy	26.9%	32.5%	< 0.001
Obesity	33.7%	36.7%	0.0002
Drug abuse	2.5%	2.4%	0.75
Alcohol abuse	3.6%	3.7%	0.69
Smoking	31.1%	31.9%	0.35
Atrial fibrillation	22.9%	14.2%	< 0.001
Admission Type, %			< 0.001
Emergent	95.%	87.2%
Elective	4.4%	12.8%
Insurance type, %			< 0.001
Medicare	62.4%	56.7%
Medicaid	7.8%	11.9%
Private	24.4%	26.2%
Other	5.3%	5.1%
Location/Teaching status of the hospital, %			0.01
Rural	7%	7.6%
Urban nonteaching	16.7%	18.3%
Urban teaching	76.3%	74.1%
Propensity Matched Outcomes	NASH with Stroke N= 3,640(50%)	NASH without Stroke N= 3,640 (50%)	p-value
In-hospital mortality, %	9.1%	2.9%	< 0.001
Mortality adjusted odds ratio	3.66(2.87 – 4.66)		< 0.001
Length of stay, in days (mean ± SD)	7.6 ± 9.1	6.1 ± 6.9	0.0007
Total hospitalization cost, in US $ (mean ± SD)	25728 ± 43929	17221 ± 31454	< 0.001
Disposition, %			< 0.001
Discharge to home	28.2%	51.9%
Transfer other: includes Skilled Nursing Facility, Intermediate Care Facility, or another type of facility	42.9%	17.3%
Home health care	15.4%	23.1%
Against medical advice	0.7%	1.1%

Table: Baseline characteristics, comorbidities and Outcomes of NASH patients with Stroke versus NASH patients without Stroke.

*Abbreviations
(NASH - Non-alcoholic steatohepatitis, SD - Standard deviation, CAD - Coronary artery disease, COPD - Chronic obstructive pulmonary disease)

Disclosures:

Devina Adalja indicated no relevant financial relationships.

Kirtenkumar Patel indicated no relevant financial relationships.

Himanshu Kavani indicated no relevant financial relationships.

Zeeshan Tirmizi indicated no relevant financial relationships.

Abdalrahman Assaassa indicated no relevant financial relationships.

Krunalkumar Patel indicated no relevant financial relationships.

Umang Patel indicated no relevant financial relationships.

Devina Adalja, MD¹, Kirtenkumar Patel, MD², Himanshu Kavani, MD³, Zeeshan Tirmizi, MD³, Abdalrahman Assaassa, MD³, Krunalkumar Patel, MD³, Umang Patel, DO³. D0492 - Patient Characteristics and In-Hospital Outcomes of Nonalcoholic Steatohepatitis in Patients With Stroke: A Propensity-Matched Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.