Soni A, Yekula A, Singh Y, Sood N, Dahiya DS, Bansal K, Abraham G. Influence of non-alcoholic fatty liver disease on non-variceal upper gastrointestinal bleeding: A nationwide analysis. World J Hepatol 2023; 15(1): 79-88 [PMID: 36744164 DOI: 10.4254/wjh.v15.i1.79]
Corresponding Author of This Article
Yuvaraj Singh, MD, Chief Medical Resident, Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. yuvarajmle@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, Kannu Bansal, GM Abraham, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Nitish Sood, Department of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
Dushyant Singh Dahiya, Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, United States
Author contributions: Soni A and Yekula A contributed to the conceptual design of the study; Soni A, Yekula A, and Soni A independently screened the medical records and extracted the data; Sood N performed the statistical analysis; Soni A, Yekula A, and Dahiya DS contributed to the write-up and submission of the study; Abraham G reviewed the final manuscript; and all authors reviewed and agreed the final content of the article.
Institutional review board statement: We utilized data from the National Inpatient Sample database, which meets all relevant ethical and regulatory standards. National Inpatient Sample is a publicly available database provided by the Agency of Healthcare Research and Quality. It includes a national representative sample of discharge-level files and does not include patient or hospital-identifiable information. Due to the nature of its complex sampling method, and being a deidentified database available for public use, institutional board review policy was met and as per the IRB policy at Saint Vincent Hospital no review or approval was required.
Informed consent statement: We utilized data from the National Inpatient Sample database, which meets all relevant ethical and regulatory standards. National Inpatient Sample is a publicly available database provided by the Agency of Healthcare Research and Quality. It includes a national representative sample of discharge-level files and does not include patient or hospital-identifiable information. Due to the nature of its complex sampling method, and being a deidentified database available for public use, informed consent was met and as per the IRB policy at Saint Vincent Hospital no review or approval was required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuvaraj Singh, MD, Chief Medical Resident, Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, United States. yuvarajmle@gmail.com
Received: September 22, 2022 Peer-review started: September 22, 2022 First decision: October 17, 2022 Revised: October 25, 2022 Accepted: November 7, 2022 Article in press: November 7, 2022 Published online: January 27, 2023 Processing time: 116 Days and 4 Hours
Abstract
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease globally with an estimated prevalence of 25%, with the clinical and economic burden expected to continue to increase. In the United States, non-variceal upper gastrointestinal bleeding (NVUGIB) has an estimated incidence of 61-78 cases per 100000 people with a mortality rate of 2%-15% based on co-morbidity burden.
AIM
To identify the outcomes of NVUGIB in NAFLD hospitalizations in the United States.
METHODS
We utilized the National Inpatient Sample from 2016-2019 to identify all NVUGIB hospitalizations in the United States. This population was divided based on the presence and absence of NAFLD. Hospitalization characteristics, outcomes and complications were compared.
RESULTS
The total number of hospitalizations for NVUGIB was 799785, of which 6% were found to have NAFLD. NAFLD and GIB was, on average, more common in younger patients, females, and Hispanics than GIB without NAFLD. Interestingly, GIB was less common amongst blacks with NAFLD. Multivariate logistic regression analysis was conducted, controlling for the multiple covariates. The primary outcome of interest, mortality, was found to be significantly higher in patients with NAFLD and GIB [adjusted odds ratio (aOR) = 1.018 (1.013-1.022)]. Secondary outcomes of interest, shock [aOR = 1.015 (1.008-1.022)], acute respiratory failure [aOR = 1.01 (1.005-1.015)] and acute liver failure [aOR = 1.016 (1.013-1.019)] were all more likely to occur in this cohort. Patients with NAFLD were also more likely to incur higher total hospital charges (THC) [$2148 ($1677-$2618)]; however, were less likely to have a longer length of stay [0.27 d (0.17-0.38)]. Interestingly, in our study, the patients with NAFLD were less likely to suffer from acute myocardial infarction [aOR = 0.992 (0.989-0.995)]. Patients with NAFLD were not more likely to suffer acute kidney injury, sepsis, blood transfusion, intubation, or dialysis.
CONCLUSION
NVUGIB in NAFLD hospitalizations had higher inpatient mortality, THC, and complications such as shock, acute respiratory failure, and acute liver failure compared to those without NAFLD.
Core Tip: Non-alcoholic fatty liver disease (NAFLD) is a growing problem. The national inpatient database was used to identify patients with non-variceal upper gastrointestinal bleeding who were categorized based on NAFLD status. Statistically significant differences were observed between the two cohorts with respect to mortality, utilization of healthcare resources and complications. We believe this will be beneficial for physicians in terms of predicting morbidity and prognosis in these patients.
