A0640 - Outcomes of Acute Mesenteric Ischemia in Patients With End-Stage Renal Disease: A Nationwide Database Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Vikash Kumar, MD

The Brooklyn Hospital Center
Brooklyn, NY

Vikash Kumar, MD¹, Vijay Gayam, MD¹, Praneeth Bandaru, MD¹, Eric Then, MD¹, Srilaxmi Gujjula, MD¹, Suut Gokturk, MD¹, Erika Vigandt, MD¹, Dhir Gala, BS², Vinaya Gaduputi, MD, FACG³, Denzil Etienne, MD¹, Madhavi Reddy, MD¹
¹The Brooklyn Hospital Center, Brooklyn, NY; ²American University of the Caribbean School of Medicine, Brooklyn, NY; ³Blanchard Valley Health System, Findlay, OH

Introduction: Acute mesenteric ischemia is an uncommon disorder occurring secondary to an abrupt obstruction in blood flow to the intestines resulting in bowel infarction. It is associated with an extremely high mortality rate. Only limited studies have evaluated this lethal disease among patients with end-stage renal disease (ESRD). We aim to determine outcomes in patients diagnosed with acute mesenteric ischemia with and without ESRD.

Methods: A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016, 2017, and 2018) and the International Classification of Diseases, Tenth Revision codes to identify the patients > 18 years old with the principal diagnosis of acute mesenteric ischemia. We compared the all-cause in-hospital mortality, length of hospital stay (LOS), and total costs between the ESRD cohort vs. non- ESRD cohort. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test.

Results: We Identified 169,245 patients with acute mesenteric ischemia, of whom 10,493 (6.2%) patients had ESRD, and 158,752 (93.8%) patients did not have ESRD. In-hospital mortality was significantly higher in patients with ESRD (OR 1.96, 95% CI: 1.66–2.32; P = 0.00). Hyperlipidemia (P < 0.01), cardiovascular comorbidity (P = 0.01), and older age (P = 0.02) were identified as predictors of higher mortality. Patients with acute mesenteric ischemia and ESRD have high odds of peritonitis (OR 2.97, 95% CI: 2.26–3.91; P = 0.00), sepsis (OR 15.7, 95% CI: 13.5–18.26; P = 0.00), and ileus (OR 1.46 95% CI: 1.10–1.95; P = 0.008) compared to patients without ESRD. Additionally, patients with ESRD had a longer LOS (7.4 days vs 5.3 days; P < 0.00), and higher total hospital cost ($91,520 vs $58,175; P < 0.00) compared to patients without ESRD.

Discussion: In patients admitted for acute mesenteric ischemia, ESRD is an independent risk factor for increased inpatient mortality. Compared to patients without ESRD, patients with ESRD have a higher risk of peritonitis, sepsis, and ileus and contribute to longer LOS and increased healthcare costs.

Table 1A

Frequency in %	ESRD (N=10,493)	Non-ESRD (158,752)	OR [95% CI]	p-value
In-hospital mortality	8.5	4.5	1.96 [1.66-2.32]	0.00
Peritonitis	3.1	1.9	2.97 [2.26-3.91]	0.00
Sepsis	7.1	3.8	15.7 [13.5-18.26]	0.00
Ileus	3.1	1.7	1.46 [1.10-1.95]	0.01
Table 1B: Patient's characteristics
Mean age	68	70
Female	52	66
Race
Caucasian	45.8	79.9		0.00
African American	32.1	9.2
Hispanic	14.1	6.6
Asian	4.0	2.0
Native American	1.0	0.3
Others	2.7	1.8
Insurance
Medicare	84.6	72.9		0.00
Medicaid	7.4	6.8
Private	7.4	1.8
Others/Uninsured	0.5	1.8
Bed size
Small	14.8	19.3		0.00
Medium	28.5	30.1
Large	56.5	50.4
Hospital Region
Northeast	20.9	21.0		0.1
Midwest	24.6	22.2
South	30.0	39.2
West	17.5	17.2
Teaching hospital	74.3	66.6		0.00
Chronic comorbidity
Diabetes mellitus	62.0	28.8		0.00
Chronic heart failure	45.1	18.9		0.00
Obesity	14.3	12.3		0.01
Dyslipidemia	46.2	46.8		0.6
Coronary artery disease	51.2	31.8		0.00

Table: Table 1A: primary and secondary outcomes of acute mesenteric ischemia in ESRD vs Non- ESRD cohort
Table 1B: patient's characteristics

Disclosures:

Vikash Kumar indicated no relevant financial relationships.

Vijay Gayam indicated no relevant financial relationships.

Praneeth Bandaru indicated no relevant financial relationships.

Eric Then indicated no relevant financial relationships.

Srilaxmi Gujjula indicated no relevant financial relationships.

Suut Gokturk indicated no relevant financial relationships.

Erika Vigandt indicated no relevant financial relationships.

Dhir Gala indicated no relevant financial relationships.

Vinaya Gaduputi indicated no relevant financial relationships.

Denzil Etienne indicated no relevant financial relationships.

Madhavi Reddy indicated no relevant financial relationships.

Vikash Kumar, MD¹, Vijay Gayam, MD¹, Praneeth Bandaru, MD¹, Eric Then, MD¹, Srilaxmi Gujjula, MD¹, Suut Gokturk, MD¹, Erika Vigandt, MD¹, Dhir Gala, BS², Vinaya Gaduputi, MD, FACG³, Denzil Etienne, MD¹, Madhavi Reddy, MD¹. A0640 - Outcomes of Acute Mesenteric Ischemia in Patients With End-Stage Renal Disease: A Nationwide Database Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.