Trends of Patients with Inflammatory Bowel Disease Developing Venous Thromboembolism: A National Inpatient Sample (NIS) Analysis

Background:

Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis and is characterized by chronic inflammation of the gastrointestinal tract. This persistent ongoing inflammation increases the risk of thrombotic events, including deep vein thrombosis (DVT), pulmonary embolism (PE), and other venous and arterial thrombosis forms. Thrombotic events can significantly impact the morbidity and mortality of IBD patients. Understanding the trends in thrombosis incidence among IBD patients is crucial for improving preventive measures and clinical management. This study aims to analyze the trends in thrombosis incidence among IBD patients over a decade using the National Inpatient Sample (NIS) database.

Objective:

To analyze the trends in the incidence of thrombosis among patients with IBD using data from the National Inpatient Sample (NIS) database.

Methods:

A retrospective analysis of the NIS database from 2016 to 2020 was conducted. The incidence rates of thrombosis in IBD (Crohn's disease and Ulcerative Colitis) patients, along with patient demographics, and clinical outcomes, were examined.

Population:

The study included patients diagnosed with IBD, identified through ICD-10 codes for Crohn's disease or regional enteritis and ulcerative colitis with underlying risk factors such as surgery, steroids, pregnancy, previous history of venous thromboembolism, family history of venous thromboembolism, who were subsequently diagnosed with thrombosis.

Outcomes:

Prevalence of thrombosis, length of hospital stay, increased total charge, complications such as in-hospital mortality, acute respiratory distress syndrome (ARDS), and sepsis.

Results:

The prevalence of thrombosis among IBD patients showed a stable trend from 2016 to 2020. Factors contributing to this trend included increased disease severity, longer hospitalizations, and an aging patient population. A total of 1123,110 inflammatory bowel disease (IBD) patients were detected using the NIS database from 2016 to 2020. Out of them, 157,23 patients were detected to have venous thromboembolism. The mean age of the patients was 57 years (p-value <0.001). Females constituted 57% (n=8962) of the patients, while males 43% (n=6760) were male (p-value <0.001). Our analysis revealed that over the years, from 2016 to 2020, the prevalence of VTE in ID patients has remained stable (1.4% in 2016, 1,5% in 2015, 1.4% in 2018, 1.5% in 2019, and 1.4% in 2020, p-value <0.001). Moreover, the presence of VTE in IBD was also found to be associated with increased odds of mortality than those without VTE (5.5% vs 1.5, aOR 2.7, p-value <0.001). The mean length of stay was also increased in patients with VTE (11 days vs 5 days in patients without VTE), along with an increase in hospitalization cost ($147,012 vs $554,92, p-value <0.001). It was also observed that the presence of VTE in IBD patients was associated with increased odds of complications as compared to patients without VTE, such as phlebitis (0.09% vs. 0.006%, aOR 14 [95%CI: 4-49], p-value <0.01), acute respiratory distress syndrome (ARDS) (0.7% vs 0.1%, aOR 0.01 ) as well as sepsis (10% vs 7%, aOR 6.8 [95% CI: 2.4-19], p-value <0.001).

Conclusion:

The rising trend of thrombosis prevalence with longer length of stay, higher total charge, and increased complications such as in-hospital mortality phlebitis, ARDS, and sepsis has increased steadily over the decade, which in patients with inflammatory bowel disease emphasizes the necessity for appropriate thromboprophylaxis and targeted preventive strategies in this high-risk population.

No relevant conflicts of interest to declare.