P4173 - Outcomes of HIV Patients With Variceal Upper Gastrointestinal Bleeding in the United States; An Analysis From the National Inpatient Sample

Kyaw Min Tun, DO¹, Renuka Verma, MD², Lily Liu, BS³, Salman Mohammed, MS³, Hemamalini Sakthivel, MD⁴, Kamleshun Ramphul, MD⁵, Banreet Dhindsa, MD⁶, Douglas Adler, MD^7
1Creighton University School of Medicine, Las Vegas, NV; ²University of Nevada, Las Vegas, NV; ³Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, NV; ⁴One Brooklyn Health-Interfaith Medical Center, New York, NY; ⁵Independent Researcher, Triolet, Pamplemousses, Mauritius; ⁶NYU Grossman School of Medicine, New York, NY; ⁷Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: There are multiple hepato- and non-hepato- (such as tumors) causes that can trigger variceal upper gastrointestinal bleeding (VUGIB). While some studies have reported potential disparities in care and outcomes among HIV patients, there is a lack of studies on the outcomes of HIV patients (vs. non-HIV cases) following VUGIB. We, therefore, aim to compare the patient characteristics and outcomes via a nationally representative set of hospital records.

Methods: The 2016-2020 National Inpatient Sample(NIS), a set of hospital records, was used to extract cases of admitted with a primary diagnosis of VUGIB among adults via ICD-10 codes. Different outcomes between patients with and without HIV were explored using multivariable regression analysis.

Results: Our selection criteria identified 36865 non-HIV and 350 HIV patients admitted with a primary diagnosis of VUGIB between 2016 and 2020 in the United States. Compared to the non-HIV group, HIV patients expressed a higher presence of various comorbidities such as COPD, liver cirrhosis, Chronic Kidney Disease (CKD), and drug abuse, as well as a higher mean CCI score (6.34 vs. 4.84, p< 0.01). However, the HIV cohort also had lower prevalence of hypertension, obesity, alcohol abuse, and lipid disorder. While both groups were predominantly males, the non-HIV group included a higher prevalence of females than the HIV cohort. Overall, the HIV group was also younger, with a mean age of 53.59 years (vs. 57.43 years)(median of 54.00. vs. 58.00, p< 0.01). Both groups were also mostly treated in urban teaching centres, and involved hospitalizations in the southern part of the US(Table 1).
After careful adjustment of confounders, we further found that while HIV patients did not have any difference in GI endoscopic investigation (vs. non-HIV group), they showed lower odds of requiring GI endoscopic intervention. They also had higher odds of using mechanical ventilation , and expressed a higher mortality rate. No differences were noted in the odds of requiring transfusion or events of hypovolemic shock between the two groups.

Discussion: Our analysis confirms that HIV patients had a poorer prognosis with higher mortality rates following admission for VUGIB. Furthermore, while no differences in GI endoscopic investigation were found, HIV patients were less likely to undergo an intervention for it. We therefore encourage further studies to understand the gaps in outcomes that can help bridge the potential disparities.


Disclosures:


Kyaw Min Tun, DO¹, Renuka Verma, MD², Lily Liu, BS³, Salman Mohammed, MS³, Hemamalini Sakthivel, MD⁴, Kamleshun Ramphul, MD⁵, Banreet Dhindsa, MD⁶, Douglas Adler, MD⁷. P4173 - Outcomes of HIV Patients With Variceal Upper Gastrointestinal Bleeding in the United States; An Analysis From the National Inpatient Sample, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.