P4162 - Ischemic Stroke Patients Bleed More: A Nationwide Inpatient Database Analysis

Umar Hayat, MD¹, Muhammad Kamal, MD², Waqas Rasheed, MD³, Hassam Ali, MD⁴, M Danial Ali Shah, MD⁵, Kamran Zahoor, MD⁶, Manesh Kumar Gangwani, MD⁷, Aamir Saeed, MD⁸, Amna Iqbal, MD⁹, Azhar Hussain, MBBS¹⁰, Dushyant S. Dahiya, MD¹¹, Faisal Kamal, MD¹², Kishore Kumar, MD^13
1Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ²Hackensack Meridian Health, Roselle Park, NJ; ³University of Kentucky, Lexington, KY; ⁴ECU Health Medical Center, Greenville, NC; ⁵King Edward Medical University, Lahore, Punjab, Pakistan; ⁶Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ⁷University of Toledo, Toledo, OH; ⁸Vanderbilt University Medical Center, Nashville, TN; ⁹University of Toledo Medical Center, Toledo, OH; ¹⁰SUNY Upstate Medical University, Syracuse, NY; ¹¹The University of Kansas School of Medicine, Kansas City, KS; ¹²Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; ¹³Geisinger Community Medical Center, Scranton, PA

Introduction: Ischemic stroke is the most common type of stroke, accounting for approximately 80% of all strokes, and is caused by blockage in the cerebrovascular system. Recent studies have shown that patients with ischemic stroke are at an increased risk of Upper gastrointestinal bleeding (UGIB), which is associated with significant morbidity and mortality. Our study aims to explore the relationship between UGIB and stroke and prognostic factors leading to worse outcomes if stroke patients have UGIB.

Methods: National Inpatient Sample (NIS) from 2016-2020 was queried using ICD-10-CM Codes to identify a cohort of inpatient admissions with a primary discharge diagnosis of ischemic stroke and a secondary diagnosis of UGIB. A weighted sample was used to get baseline characteristics, length of hospital stays (LOS), and resource utilization during the inpatient admissions. Multivariate logistic regression analysis followed by predictive margins was used to obtain adjusted estimates of the length of hospital stay, mechanical ventilation, shock development, resource utilization, and mortality.

Results: Among 503345 patients hospitalized with ischemic stroke, 1215 (0.24%) patients had a concurrent diagnosis of UGIB; compared to males, females with ischemic stroke were less likely to have UGIB (58.7% vs. 41.3%). The mean age was similar in both groups (69.7 years vs. 72.5 years). The patients admitted with ischemic stroke, and UGIB has medicare insurance as their primary payer. Patients with ischemic stroke with UGIB were more likely to go into shock (9.1% vs. 0.13%) and have mechanical ventilation (3.3% vs. 1.2%), resulting in a more extended LOS than those without UGIB (10.85d vs. 4.52d)—table 1. On multivariate analysis, patients with ischemic stroke were more likely to have extended hospitalization aOR: 5.22 days (95% CI: 4.09- 6.35) and higher hospital charges (74368.87 (95% CI: 56666.05 - 92071.68), which were statistically significant. Moreover, these patients have a higher mortality aOR: 2.12 (95% CI: 1.36- 3.31) than those without UGIB Figure 1.

Discussion: This study demonstrated that patients with ischemic stroke who had UGIB were more likely to be admitted to the ICU and had an increased LOS and a higher mortality. Furthermore, these patients had higher total hospitalization charges than those without UGIB. It underscores the importance of early recognition of high-risk individuals at an increased risk of UGIB to optimize their health care for better health outcomes.



Disclosures:


Umar Hayat, MD¹, Muhammad Kamal, MD², Waqas Rasheed, MD³, Hassam Ali, MD⁴, M Danial Ali Shah, MD⁵, Kamran Zahoor, MD⁶, Manesh Kumar Gangwani, MD⁷, Aamir Saeed, MD⁸, Amna Iqbal, MD⁹, Azhar Hussain, MBBS¹⁰, Dushyant S. Dahiya, MD¹¹, Faisal Kamal, MD¹², Kishore Kumar, MD¹³. P4162 - Ischemic Stroke Patients Bleed More: A Nationwide Inpatient Database Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.