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CC BY 4.0 · TH Open 2020; 04(01): e51-e58
DOI: 10.1055/s-0040-1710506
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Inflammatory Bowel Disease and Thrombosis: A National Inpatient Sample Study

Jessica B. Cohen
1   Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States
2   University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Diane M. Comer
3   University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania, United States
,
Jonathan G. Yabes
3   University of Pittsburgh Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania, United States
,
Margaret V. Ragni
1   Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, United States
2   University of Pittsburgh, Pittsburgh, Pennsylvania, United States
› Author Affiliations Funding This study was supported, in part, by Health Resources & Services Administration (HRSA) Federal Hemophilia Treatment centers Grant, 4500 Fishers Lane, Rockville, MD 20857 (Grant H30MC24050–04–00); National Institutes of Heart, Lung, Blood Institute (NHLBI), Building 31, 31 Center Drive, Bethesda, MD 20892 (NHLBI 2T35-HL074708–13); and Pennsylvania Department of Health (DOH), Harrisburg, PA 17108, State Support of Hemophilia Center of Western PA (SAP no.: 41000058531).
Further Information

Publication History

20 December 2019

07 April 2020

Publication Date:
18 May 2020 (online)

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Abstract

Introduction Thrombosis is more common in inflammatory bowel disease (IBD) patients than the general population, but disease-specific correlates of thrombosis remain unclear.

Methods We performed a retrospective analysis of discharge data from the National Inpatient Sample between 2009 and 2014, using International Disease Classification codes to identify IBD and non-IBD patients with or without thrombosis. We used NIS-provided discharge-level weights to reflect prevalence estimates. Categoric variables were analyzed by Rao-Scott Chi-square test, continuous variables by weighted simple linear regression, and covariates associated with thrombosis by weighted multivariable logistic regression.

Results Thrombosis prevalence in IBD was significantly greater than in non-IBD, 7.52 versus 4.54%, p < 0.0001. IBD patients with thrombosis were older and more likely to be Caucasian than IBD without thrombosis, each p < 0.001. Thrombosis occurred most commonly in the mesenteric vein. Thrombotic risk factors in IBD include surgery, ports, malignancy, dehydration, malnutrition, and steroids at 53.7, 13.2, 13.1, 12.4, 8.9, and 8.2%, respectively. Those with thrombosis had greater severity of illness, 1.42 versus 0.96; length of stay, 7.7 versus 5.5 days; and mortality, 3.8 versus 1.5%; all p < 0.0001. Adjusting for age and comorbidity, odds ratios for predictors of thrombosis included ports, steroids, malnutrition, and malignancy at 1.73, 1.61, 1.34, and 1.13, respectively, while Asian race, 0.61, was protective, each p < 0.001.

Conclusion Thrombosis prevalence is 1.7-fold greater in IBD than non-IBD patients. Adjusting for age and comorbidity, the odds ratio for thrombosis in IBD was 73% higher with ports, 61% higher with steroids, 34% with malnutrition, and 13% with malignancy. Whether long-term anticoagulation would benefit the latter is unknown.

Keywords

inflammatory bowel disease - malignancy - malnutrition - steroids - thrombosis

Authors' Contributions

J.B.C. and M.V.R. contributed to the study design, data acquisition, interpretation of the data and writing of the manuscript. D.M.C. contributed to data acquisition, performance of the data analysis, and critical review of the manuscript. J.G.Y. contributed to the study design, data acquisition, performance of the data analysis, and critical review of the manuscript. The dataset and analysis of the selected years from the NIS can be obtained by contacting the corresponding author.


 

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