Clinical Outcomes And Mortality in Heart Failure And Chronic Kidney Disease Patients Admitted With Non-Variceal Upper Gastrointestinal Bleeding

Abstract

Background/Synopsis

Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Non-variceal upper gastrointestinal bleeding (NVUGIB) can be associated with various medical conditions, including heart failure (HF) and CKD. CKD and HF has been shown to further increase cardiovascular risks.

Objective/Purpose

Nevertheless, there is limited scientific evidence of clinical outcomes of NVUGIB in patients with CKD & HF. Hence, we sought to investigate this population.

Methods

We queried National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with NVUGIB and had CKD & HF. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), intubation, length of stay (LOS) and total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. P-value < 0.05 was significant.

Results

There were 3,349,779 hospitalizations with NVUGIB and 459,980 (13.7%) had CKD & HF. HF & CKD and non-HF & CKD cohorts were with mean age of 74 vs. 66 yrs; males 46.9% vs 53.1%; Caucasians 63.5% vs 66.6%; HTN 8% vs 39%; dyslipidemia 53.3% vs 37.2%; PE 3.9% vs 4.9%; DM 56% vs 30.4%; AF 24.4% vs 23.5%; obesity 19.5% vs 13.3%; AF 50.2% vs 21.1%; history of stroke 2.0% both, COPD 33.5% vs 18.4%; alcohol use 3% vs 13.8%, respectively. HF & CKD cohort had significantly higher mortality and worse clinical outcomes (Table 1).

Conclusions

HF & CKD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were older, obese, female, fewer Caucasians, with more frequent dyslipidemia, DM, AF and COPD. HF & CKD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. HF & CKD is an important predictor of adverse outcomes in NVUGIB population. Further research is necessary to describe long-term outcomes.