Factors Associated with in-Hospital Mortality from Gastrointestinal Bleeding in Patients with Sickle Cell Disease

Introduction

Gastrointestinal bleeding (GIB) is a common complication and potential cause of mortality in hospitalized patients. Previous studies have shown that patients with SCD have an increased risk of developing GIB. There is a paucity of literature addressing factors that could predict GIB mortality in patients with SCD. Our study aims to identify these factors and other clinical characteristics of GIB in patients with SCD.

Methods

Data for this study were obtained from the National Inpatient Sample (NIS) database. We identified patients with SCD aged 18 years and older who had GIB between 2016 and 2020. The primary outcome was in-hospital mortality. Patient demographics, clinical and hospital characteristics were compared using x² test. The association between SCD 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 1284 patients with SCD who had GIB during the study period. 51.25% (n=658) were aged ≥40 years old 48.75% (n=626) were <40 years. 42.21% (n=542) of patients had lower GIB compared to 38.01% (n=488) with upper GIB. 5.61% (n=72) of patients died from GIB. Patients with cerebrovascular disease (CVD) (aOR= 3.62 [95% CI: 1.23-10.67] p-value: 0.019), sepsis(aOR= 14.48 [95% CI:7.70-27.21] p-value: <0.001) and acute kidney injury (AKI) (aOR= 3.54 [95%CI:1.87-6.70]p-value:0.0001) had a increased risk of inpatient mortality from GIB compared to other patients. Vaso-occlusive crisis and acute chest syndrome did not show a significant risk for mortality from GIB. There was no significant association between race, gender, income, or insurance with inpatient mortality.

Conclusion

Our study demonstrates a relationship between AKI, Sepsis and CVD and in-hospital mortality of GIB in patients with SCD. Understanding these factors will assist clinicians in anticipating potential mortality in patients with SCD who develop GIB. Our study was limited by a small sample size. More research is needed to identify factors that could improve survival of GIB in patients with SCD.

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