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End-Stage Renal Disease and Lower Gastrointestinal Bleeding - A Propensity-matched Analysis of Nationwide Inpatient Sample.
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  • Pavani Reddy Garlapati,
  • Bhavesh Gajjar,
  • Eric Then,
  • Vijay Gayam
Pavani Reddy Garlapati
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Bhavesh Gajjar
East Tennessee State University
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Vijay Gayam
Interfaith Medical Center
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Abstract

Introduction: We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay, and resource utilization in end-stage renal disease (ESRD) patients. Material and Methods: The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS), and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients. Results: We identified 2187954 ESRD patients, of whom 242075 has LGIB, and 1945879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P=0.00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P=0.00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P=0.002). Advanced age (OR 1.02 CI 1.02-1.03 P=0.00), anemia (OR 1.04 CI 1.59-1.91 P=0.006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P=0.00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P=0.00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P=0.00), and sepsis (OR 1.5, CI 4.1-5.08, P=0.00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8±14.9 vs. 6.3±8.5, P<0.01) and mean total charges (37054 $ vs. 18080 $, P<0.01) were also higher. Conclusions: In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation, and shock requiring vasopressor. Mean LOS and resource utilization were also higher.

Peer review status:Published

02 Jun 2020Submitted to International Journal of Clinical Practice
04 Jun 2020Assigned to Editor
04 Jun 2020Submission Checks Completed
25 Jun 2020Reviewer(s) Assigned
24 Jul 2020Review(s) Completed, Editorial Evaluation Pending
24 Jul 2020Editorial Decision: Accept
02 Aug 2020Published in International Journal of Clinical Practice. 10.1111/ijcp.13633