Background: Epidemiology of Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) such as peptic ulcer bleeding, Mallory-Weiss tear, erosive gastritis/duodenitis, oesophagitis/oesophageal ulcer is well known among general population. However, data is lacking about its trend among Cirrhotic population in literature. No large database study is available to compare prevalence, predictors, and outcomes of NVUGIB among Cirrhotic patients. We aim to determine the hospitalization trend, predictors, and outcomes of NVUGIB in patients with Cirrhosis using largest population database.
Methods: A population-based retrospective cross-sectional analysis of the National Inpatient Sample (NIS) for years 2007-2018 was performed. Hospitalizations due to NVUGIB among cirrhotic patients were identified using International Classification of Diseases (9th/10th Edition) Clinical Modification Procedural codes (ICD-9/10-CM) diagnosis codes which have been previously validated. Diagnoses of interests and other co-morbidities were identified by ICD-9/10-CM codes and Elixhauser co-morbidity software. Multi-variable survey logistic regression was performed to analyses temporal trends, predictors and outcomes using SAS 9.4 analytical software.
Results: Out of a total 9,804,819 hospitalizations among cirrhotic patients during 2007-2018, 160,194 (1.6%) were due to NVUGIB. Trend of NVUGIB remained stable from 2.0% in 2007 to 1.7% in 2018 (ptrend:0.08). Cirrhotic patients who were admitted due to NVUGIB were younger (57 vs 59; p< 0.001) and predominantly male (64% vs. 36%, p< 0.001). Furthermore, in multi-variable regression analysis, age [10-year increment] (OR 1.1; 95% CI 1.1-1.2; p< 0.001), males (OR 1.1; 95% CI 1.1-1.1; p< 0.001), West Region (OR 1.4; 95% CI 1.3-1.4; p< 0.001), H. Pylori infection (OR 13.6; 95% CI 12.6-14.8; p< 0.001), and Alcoholism (OR 2.6; CI 2.5-2.6; p<0.001) were associated with higher odds of NVUGIB. Moreover, co-morbidities such as hypertension, valvular heart diseases, NSAID use, and smoking were also associated with the higher rates of hospitalization due to NVUGIB. Among patients who admitted due to NVUGIB, 14.7% were discharged to facilities and 5.0% died during the hospitalization. Mean length of stay of hospitalization due to NVUGIB was 6-days.
Conclusions: In this study we were able to demonstrate epidemiology of hospitalizations due to NVUGIB among Cirrhotic patients. We also identified several predictors associated with NVUGIB among Cirrhosis patients and some of them are modifiable. NVUGIB is associated with significant in-hospital mortality and morbidity. More in-depth studies are warranted to identify causal factors and develop preventive strategies among these high-risk population to further improve the outcomes.