Factors Associated with in-Hospital Mortality from Gastrointestinal Bleeding in Patients with Hemophilia

Introduction

Gastrointestinal bleeding (GIB) is a common complication and potential cause of mortality in hospitalized patients. Patients with hemophilia (PWH) have an increased risk of developing GIB compared to patients without hemophilia. There is a paucity of literature addressing factors that could predict GIB mortality in PWH. Our study aims to identify these factors and other clinical characteristics of GIB in PWH.

Method

Data for this study were obtained from the National Inpatient Sample (NIS) database. We identified PWH aged 18 years and older who had GIB between 2016 and 2020. Patients were categorized into hemophilia A and B. The primary outcome was in-hospital mortality. Patient demographics, clinical and hospital characteristics were compared using x² test. The association between hemophilia type and in-hospital mortality was assessed using logistic regression controlling for other covariate. A two-sided p≤0.05 was considered statistically significant.

Results

We identified 638 PWH who had GIB, 22.1% (n=141) had Hemophilia A and 77.9% (n=497) had Hemophilia B. 77.12% (n=492) were male, and 22.88% (n=146) were female. 78.06% (n=498) were ≥40 years old and 21.94% (n=140) were <40 years old. Non-Hispanic Whites (NHWs) had less patients with Hemophilia A than B (59.56% vs 74.47%) compared to non-Hispanic Blacks (NHBs) (19.12% vs 13.47%), Hispanics (12.27% vs 3.55%) and Non-Hispanic Others (6.64% vs 4.96%) who had more patients with Hemophilia A than B (p=0.003). The in-hospital mortality of GIB in PWH was 5% (n=32). More patients with Hemophilia A died from GI bleed compared to Hemophilia B (5.9% vs 2.1%), this finding was however not statistically significant. Patients with a higher comorbidity index had higher inpatient mortality than those with co-morbidity index of 0(aOR:5.26, CI95%:1.94-14.23, p=0.001). There was no association between type of Hemophilia, race, gender, income, insurance, or location of GI bleed with inpatient mortality.

Conclusion

Our study demonstrates that the presence of co-morbidities increases in-hospital mortality from GIB in patients with Hemophilia. We also observed that NHWs with Hemophilia B had more episodes of GIB than those with Hemophilia A, while the reverse was true in other racial groups. Our study was limited by a small sample size. More research is needed to identify factors that could improve survival of GIB in PWH.

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