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
ARTICLE HIGHLIGHTS
Research background
With the increasing prevalence, morbidity and mortality of non-alcoholic fatty liver disease (NAFLD), and worse outcomes with concomitant conditions, we wanted to determine the effect of NAFLD on a commonly seen in-patient presentation, non-variceal upper gastrointestinal bleeding (NVUGIB).
Research motivation
There are studies showing the effect of alcoholic liver disease on both variceal and NVUGIB, along with studies showing an increased risk of variceal bleeding and screening in patients with NAFLD. However, there have been no studies showing the influence of NAFLD on NVUGIB. Our aim was to try to bridge this gap.
Research objectives
Our objective was to examine whether the presence of NAFLD led to worse outcomes in patients with NVUGIB.
Research methods
We used the National Inpatient Sample database to ensure generalizability of findings. We compared the two cohorts of NAFLD with and without NVUGIB on the basis of mortality which was the primary outcome and secondary outcomes such as the length of stay, hospital charges, and complications.
Research results
It was shown that patients with NVUGIB and NAFLD had higher odds of mortality, higher hospital charges and more complications such as shock, acute respiratory failure and acute liver failure.
Research conclusions
Co-existence of NAFLD and NVUGIB was associated with higher mortality, morbidity and economic burden.
Research perspectives
Because of increased morbidity and mortality due to NAFLD, aggressive risk management should be a focus. Also, further studies should be performed to stratify patients with NAFLD that are at higher risk of NVUGIB so that they can be identified by clinicians and the mortality, morbidity and economic burden can be reduced.
