A0354 - Association of Myeloproliferative Disorders in Inflammatory Bowel Disease - An Epidemiological, Outcome and Healthcare Utilization Analysis of the National Inpatient Sample Database

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Tushar Khanna, MD

St. Mary Mercy Hospital
FARMINGTON HILLS, MI

Tushar Khanna, MD¹, Zarak Khan, MD², David Steinberger, MD¹, Mark C. Mattar, MD³, Preeti Misra, MD¹
¹St. Mary Mercy Hospital, Livonia, MI; ²Vidant Medical Center, Greenville, NC; ³MedStar Georgetown University Hospital, Washington, DC

Introduction: Chronic inflammation and a similar genetic & haplotype profile appears to underly the etiology of both inflammatory bowel disease(IBD) & myeloproliferative disorders(MPN). Recent studies show an increased risk of MPN in patients with IBD & vice versa. Few large scale population based studies have investigated the association of IBD patients with MPD including Essential Thrombocythemia(ET),Polycythemia Vera(PV),Chronic myeloid leukemia (CML) & Myelofibrosis (MF). Here, we investigated the National Inpatient Sample (NIS) database, the largest all-payer inpatient database in USA, to study trends of hospitalized IBD patients with MPD.

Methods: We analyzed NIS data for all adults hospitalized with IBD as a principal diagnosis & MPD as the secondary discharge code using validated ICD-9 &10 codes between 2010-19. Descriptive statistics & regression analysis were used to analyze patient characteristics, comorbidities, length of stay(LOS), hospital charges & outcomes in patients with IBD&MPD & those without.

Results: In 2010-19, a total of 3374 of 187227 (1.8%) hospitalizations for IBD were related to MPD. ET was the most common MPD (94.9%), followed by PV (2.1%). Patients with MPD & IBD were slightly younger (median age, 41.12), more African American & Hispanic with Medicaid as their primary insurance. Hospitalized IBD patients with MPD were noted to have higher rates of rectal bleeding (15.95% vs 8.8%, p< 0.001); intestinal abscess formation (4.65% vs 3.66%, p=0.003) & perforation (1.66% vs 1.24, p value=0.035). There were lower rates of intestinal obstruction (7.44% vs 12.67%, p< 0.001) & colectomy (8.62% vs 10.73%, p< 0.001) compared to patients without MPD. Patients with MPD & IBD appear to have a higher major & extreme risk of disease severity (42.74% vs 25.62%, p< 0.001) & mortality (12.21% vs 9.48%) based on the APRDRG Severity & mortality scores.They also had a longer length of stay, median, 5 days vs 4 days, p value< 0.001; & higher cost per hospitalization, median, 8199.79 $ vs 7110.6$, p value< 0.001

Discussion: IBD patients hospitalized with MPD appear to have a higher incidence of rectal bleeding, intestinal perforation and abscess formation along with an increased risk of disease severity & mortality. This relates to a higher LOS & cost per hospitalization. Impaired immune regulation with combined MPN & IBD could be a contributor towards this but further studies are needed to understand how MPD affects severity & risk of complications in hospitalized IBD patients.

	Overall	IBD-MPN	IBD+MPN
*Variable*	N = 187,227	N = 183,853	N = 3,374	P Value
Rectal Bleeding	16723 (8.93%)	16185 (8.8%)	538 (15.95%)	< 0.001
Intestinal Obstruction	23545 (12.58%)	23294 (12.67%)	251 (7.44%)	< 0.001
Intestinal Fistula	10669 (5.7%)	10457 (5.69%)	212 (6.28%)	0.149
Intestinal Abscess	6890 (3.68%)	6733 (3.66%)	157 (4.65%)	0.003
Colectomy	20013 (10.69%)	19722 (10.73%)	291 (8.62%)	< 0.001
Peritonitis	507 (0.27%)	493 (0.27%)	14 (0.41%)	0.145
Intestinal Perforation	2334 (1.25%)	2278 (1.24%)	56 (1.66%)	0.035
Note. p-values from chi-square to independent samples t-tests.

		Overall	IBD-MPN	IBD+MPN

*Variable*	Label	N = 187,227	N = 183,853	N = 3,374	P Value
Mortality	Alive	186512 (99.67%)	183148 (99.67%)	3364 (99.73%)	0.627
	Died	616 (0.33%)	607 (0.33%)	9 (0.27%)
LOS, day, median [IQR]		4 [2, 6]	4 [2, 6]	5 [3, 8]	< 0.001
APRDRG Severity	Major/Extreme	48542 (25.93%)	47100 (25.62%)	1442 (42.74%)	< 0.001
	Minor/Moderate	138685 (74.07%)	136753 (74.38%)	1932 (57.26%)
APRDRG Risk Mortality	Major/Extreme	17837 (9.53%)	17425 (9.48%)	412 (12.21%)	< 0.001
	Minor/Moderate	169390 (90.47%)	166428 (90.52%)	2962 (87.79%)
Total Cost,$, median [IQR]		7129.81 [4580.68, 12316.36]	7110.6 [4567.87, 12282.43]	8199.79 [5407.92, 14563.4]	< 0.001

Disclosures:

Tushar Khanna indicated no relevant financial relationships.

Zarak Khan indicated no relevant financial relationships.

David Steinberger indicated no relevant financial relationships.

Mark Mattar: Abbvie – Advisor or Review Panel Member, Speakers Bureau. BMS – Advisor or Review Panel Member, Consultant, Speakers Bureau. Janssen – Advisory Committee/Board Member, Speakers Bureau. Pfizer – Advisor or Review Panel Member, Speakers Bureau. Takeda – Speakers Bureau.

Preeti Misra indicated no relevant financial relationships.

Tushar Khanna, MD¹, Zarak Khan, MD², David Steinberger, MD¹, Mark C. Mattar, MD³, Preeti Misra, MD¹. A0354 - Association of Myeloproliferative Disorders in Inflammatory Bowel Disease - An Epidemiological, Outcome and Healthcare Utilization Analysis of the National Inpatient Sample Database, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.