TY - JOUR
T1 - National Trends and Outcomes of Nonautoimmune Hemolytic Anemia in Alcoholic Liver Disease
T2 - Analysis of the Nationwide Inpatient Sample
AU - Tariq, Tooba
AU - Karabon, Patrick
AU - Irfan, Furqan B.
AU - Sieloff, Eric M.
AU - Patterson, Rachel
AU - Desai, Archita P.
N1 - Funding Information:
Received for publication November 8, 2019; accepted March 1, 2020. From the Departments of *Geriatric Medicine; ¶Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN; †Oakland University William Beaumont School of Medicine, Detroit; ‡College of Osteopathic Medicine, Michigan State Uni-versity, East Lansing; §Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo; and ∥Oakland University William Beaumont School of Medicine, Rochester, MI. A.P.D. is funded by the American Association for the Study of Liver Disease Foundation’s 2017 Career Development Award. The authors declare that they have nothing to disclose. Address correspondence to: Tooba Tariq, MD, Department of Geriatric Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 (e-mail: ttariq@iu.edu). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000001383
Publisher Copyright:
© Copyright 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Goal:The aim of this study was to determine the burden of nonautoimmune hemolytic anemia (NAHA) in hospitalized patients with coexisting alcoholic liver disease (ALD), identify risk factors for NAHA in ALD and describe the hospitalization outcomes.Background:ALD can result in structural and metabolic alterations in the red-blood cell membrane leading to premature destruction of erythrocytes and hemolytic anemia of varying severity.Study:Hospitalized ALD patients with concomitant NAHA were identified in the Nationwide Inpatient Sample database using International Classification of Diseases-9 codes from 2009 to 2014. The primary outcome was to determine the nationwide prevalence and risk factors of NAHA in patients hospitalized with ALD.Results:The prevalence of NAHA was 0.17% (n=3585) among all ALD patients (n=2,125,311) that were hospitalized. Multivariate analysis indicated higher odds of NAHA in ALD patients in the following groups: female gender [adjusted odds ratio (AOR) AOR 1.80, P<0.0001]; highest quartile of median household income (AOR 1.88, P<0.0001); increasing Charlson-Deyo Comorbidity Index (3 to 4 vs. 0, AOR 2.16, P=0.0042) and cirrhosis (AOR 2.74, P<0.0001). Discharges of ALD with anemia had a significantly longer average length of stay (8.8 vs. 6.0 d, P<0.0001), increased hospital charges ($38,961 vs. $25,244, P<0.0001) and higher mortality (9.0% vs. 5.6%, P<0.0001) when compared with ALD with no anemia.Conclusion:NAHA in patients with ALD is an important prognostic marker, predicting a longer, costlier hospitalization and increased inpatient mortality in ALD.
AB - Goal:The aim of this study was to determine the burden of nonautoimmune hemolytic anemia (NAHA) in hospitalized patients with coexisting alcoholic liver disease (ALD), identify risk factors for NAHA in ALD and describe the hospitalization outcomes.Background:ALD can result in structural and metabolic alterations in the red-blood cell membrane leading to premature destruction of erythrocytes and hemolytic anemia of varying severity.Study:Hospitalized ALD patients with concomitant NAHA were identified in the Nationwide Inpatient Sample database using International Classification of Diseases-9 codes from 2009 to 2014. The primary outcome was to determine the nationwide prevalence and risk factors of NAHA in patients hospitalized with ALD.Results:The prevalence of NAHA was 0.17% (n=3585) among all ALD patients (n=2,125,311) that were hospitalized. Multivariate analysis indicated higher odds of NAHA in ALD patients in the following groups: female gender [adjusted odds ratio (AOR) AOR 1.80, P<0.0001]; highest quartile of median household income (AOR 1.88, P<0.0001); increasing Charlson-Deyo Comorbidity Index (3 to 4 vs. 0, AOR 2.16, P=0.0042) and cirrhosis (AOR 2.74, P<0.0001). Discharges of ALD with anemia had a significantly longer average length of stay (8.8 vs. 6.0 d, P<0.0001), increased hospital charges ($38,961 vs. $25,244, P<0.0001) and higher mortality (9.0% vs. 5.6%, P<0.0001) when compared with ALD with no anemia.Conclusion:NAHA in patients with ALD is an important prognostic marker, predicting a longer, costlier hospitalization and increased inpatient mortality in ALD.
KW - alcoholic liver disease
KW - hemolytic anemia
KW - liver transplant
KW - Nationwide Inpatient Sample
KW - spur cell
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U2 - 10.1097/MCG.0000000000001383
DO - 10.1097/MCG.0000000000001383
M3 - Article
C2 - 32740099
AN - SCOPUS:85095588832
VL - 55
SP - 258
EP - 262
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
SN - 0192-0790
IS - 3
ER -