P2451 - Predictors of Gastrointestinal Bleeding in Patient with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis

Tarek Aboursheid, MD¹, Azizullah Beran, MD², Adel Hajj Ali, MD³, Mohamad Hijazi, MD⁴, Mhd K. Albuni, MD⁵, M Kenan Rahima, MD⁶, Bisher Sawaf, MD⁷, Nicholas Olchawa, ⁸, Monzer Abdalla, MD¹, Mohammad Al-Haddad, MD, FACG², John Guardiola, MD^2
1Ascension Saint Francis Hospital, Evanston, IL; ²Indiana University School of Medicine, Indianapolis, IN; ³Indiana University, Indianapolis, IN; ⁴Trihealth Good Samaritan Hospital, Cincinnati, OH; ⁵TriHealth, Cincinnati, OH; ⁶TriHealth Good Samaritan Hospital, Cincinnati, OH; ⁷University of Toledo Health Sciences Campus, Toledo, OH; ⁸Indiana University School of Medicine, Crown Point, IN

Introduction: Gastrointestinal (GI) bleeding is a serious and potentially life-threatening complication for patients with a left ventricular assist device (LVAD). With the growing use of LVADs in treating advanced heart failure, identifying the risk factors for GI bleeding in this population is essential for improving patient outcomes. Despite numerous studies on this topic, the results have been inconsistent. Therefore, we conducted a systematic review and meta-analysis to precisely assess the risk factors associated with GI bleeding in patients with LVAD.

Methods: We searched Embase, PubMed, and Web of Science databases from inception until May 2024 for published studies that assessed risk factors for GI bleeding in patients with LVAD after adjustment for potential confounders and reported the data as adjusted hazard ratios (HR) with 95% confidence intervals. Studies reporting unadjusted risk factors were excluded. Meta-analyses were conducted using a random-effects model, and pooled adjusted HRs for risk factors reported in ≥3 studies were calculated.

Results: Eighteen studies with 118,028 patients on LVAD support were included. Nine unique risk factors were analyzed (Figure 1). A prior history of GI bleeding (HR 2.44, 95% CI: 1.75-3.38), moderate to severe right ventricular dysfunction (1.32, CI: 1.13-1.54), diabetes mellitus (1.32, CI: 1.03-1.68), and higher creatinine levels (1.21, CI: 1.16-1.27) were found to be independent risk factors for GI bleeding following LVAD implantation. Older age was also a significant predictor of GI bleeding, whether assessed as a continuous variable (1.19, CI: 1.12-1.26) or categorical variable (1.61, CI: 1.37-1.91). Female gender (1.24, CI: 1.00-1.53) and ischemic cardiomyopathy (1.27, CI: 1.00-1.60) showed a trend towards higher risk of GI bleeding, but this was not statistically significant. However, higher BUN levels and the use of ACEI/ARBs were not associated with an increased risk of GI bleeding post-LVAD.

Discussion: Our meta-analysis focused on adjusted risk factors to provide precise estimates of the independent predictors of GI bleeding following LVAD implantation. Incorporating our findings into a risk stratification model may reliably identify high-risk patients for GI bleeding following LVAD implantation. This can facilitate the implementation of preventative strategies, targeted monitoring, and interventions to reduce the incidence of GI bleeding following LVAD implantation and improve patient outcomes.



Disclosures:


Tarek Aboursheid, MD¹, Azizullah Beran, MD², Adel Hajj Ali, MD³, Mohamad Hijazi, MD⁴, Mhd K. Albuni, MD⁵, M Kenan Rahima, MD⁶, Bisher Sawaf, MD⁷, Nicholas Olchawa, ⁸, Monzer Abdalla, MD¹, Mohammad Al-Haddad, MD, FACG², John Guardiola, MD². P2451 - Predictors of Gastrointestinal Bleeding in Patient with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.