P0746 - Frailty Predicts Mortality and Procedural Performance in Patients With Non-Variceal Upper Gastrointestinal Bleed: Results From Nationwide Analysis

Award: Presidential Poster Award

Ali Jaan, MD¹, Zouina Sarfraz, MBBS², Ashish Dhawan, MBBS³, Umer Farooq, MD⁴, Ammad Javaid. Chaudhary, MD⁵, Mahesh Nepal, MD¹, Laraib Fatima. Sheikh, ⁶, Savanna Thor, DO, MPH^7
1Rochester General Hospital, Rochester, NY; ²Fatima Jinnah Medical University, Lahore, Punjab, Pakistan; ³Gian Sagar Medical College and Hospital, Chandigarh, Chandigarh, India; ⁴SSM Health Saint Louis University Hospital, St. Louis, MO; ⁵Henry Ford Health, Detroit, MI; ⁶Lahore Medical and Dental College, Rochester, NY; ⁷SUNY Downstate Health Sciences University, Brooklyn, NY

Introduction: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization in the United States. With approximately 400,000 admissions annually and a mortality rate of 5-10%, it has a substantial burden on the U.S. healthcare system. Frailty, a multifaceted syndrome characterized by a decline in the function of organ systems, is generally linked to worse outcomes. However, its specific implications on NVUGIB are yet to be comprehensively analyzed. This study aims to bridge this research gap by conducting a nationwide analysis.

Methods: Using the National Readmission Database (NRD) from 2019, we employed the International Classification of Diseases, 10th revision, Clinical Modifications (ICD-10-CM) codes to identify adult patients (aged ≥18 years) admitted with a principal diagnosis of NVUGIB. We further stratified NVUGIB hospitalizations based on the presence of frailty. Utilizing a multivariate regression model, we assessed the impact of frailty on outcomes and procedural performance in NVUGIB hospitalizations. STATA 14.2 was utilized for statistical analysis.

Results: We included 218,647 adult patients admitted with NVUGIB, of whom 99,892 (45.69%) patients were frail (Table 1). After adjusting for confounding variables, in-hospital mortality due to NVUGIB was significantly higher in frail patients (adjusted odds ratio [aOR] 5.64; P< 0.01). Additionally, frail patients had elevated odds of acute kidney injury (AKI), hemorrhagic shock, vasopressor requirement and respiratory failure requiring mechanical ventilation (P< 0.01). Procedural analysis revealed lower odds of overall esophagogastroduodenoscopy (EGD) and EGD within 24 hours but higher odds of rebleeding requiring repeat EGD and radioembolization (P< 0.01) (Figure 1). Finally, resource utilization estimated by total hospitalization charges (THC), length of stay (LOS), discharge to rehabilitation facilities, and 30-day readmission rates were also significantly higher among patients with malnutrition (P< 0.01).

Discussion: Our study underscores the significant association between frailty and various critical endpoints of NVUGIB, including AKI, shock and respiratory failure, in-hospital mortality and costs. Additionally, frailty emerged as an independent predictor of procedural intervention performed as well as resource utilization. Recognizing frailty as a determinant of NVUGIB outcomes can aid clinicians in risk stratification for this population.



Disclosures:


Ali Jaan, MD¹, Zouina Sarfraz, MBBS², Ashish Dhawan, MBBS³, Umer Farooq, MD⁴, Ammad Javaid. Chaudhary, MD⁵, Mahesh Nepal, MD¹, Laraib Fatima. Sheikh, ⁶, Savanna Thor, DO, MPH⁷. P0746 - Frailty Predicts Mortality and Procedural Performance in Patients With Non-Variceal Upper Gastrointestinal Bleed: Results From Nationwide Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.