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Sickle cell disease is associated with higher mortality among patients hospitalized with ischemic bowel disease

Akanbi, Olalekana,*; Adejumo, Adeyinka C.d,*; Saleem, Nasirc; Francisque, Frantza; Soliman, Mohanada; Ogunbayo, Gbolahan O.b

European Journal of Gastroenterology & Hepatology: September 2018 - Volume 30 - Issue 9 - p 1027–1032
doi: 10.1097/MEG.0000000000001181
Original Articles: Gastroenterology

Background Sickle cell disease (SCD) is the most common inheritable hematologic disorder in the USA and is associated with ischemic organ diseases. SCD-associated ischemic bowel disease is increasing being recognized, and studies on the hospitalization outcomes of such patients are limited.

Objective This study aimed to compare the inpatient outcomes of ischemic bowel disease among patients with SCD compared with patients without SCD.

Materials and methods This is a case–control study using data from the National Inpatient Sample Database (2007–2014). We analyzed and compared outcomes between cases (ischemic bowel disease with SCD) and controls (ischemic bowel disease without SCD), matched in a 1 : 5 ratio. The primary outcome was in-hospital mortality, and the secondary outcomes were healthcare resource utilization including mechanical ventilation, hemodialysis, transfusion, length of stay, and hospital charges.

Results Of the 194 262 patients admitted with ischemic bowel disease, 98 had a diagnosis of SCD and were matched successfully to the controls. In multivariate analysis, patients with SCD had twice the mortality odds of those without (adjusted odds ratio=2.06, 95% confidence intervals: 1.13–3.74). They were more likely to require mechanical ventilation and blood transfusion, and to be discharged to secondary health facilities [1.68 (1.02–2.76), 3.32 (2.15–5.12), and 1.84 (1.02–3.35)]. Patients with SCD also had a higher frequency of pneumonia, acute respiratory failure, and hemodialysis for acute renal failure. There was no significant difference in the length of stay or the total hospital charge between the two groups.

Conclusion In patients hospitalized with ischemic bowel disease, SCD is associated with significantly increased mortality and healthcare burden.

aDepartment of Internal Medicine, Division of Hospital Medicine, University of Kentucky College of Medicine

bDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky

cDepartment of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Illinois

dDepartment of Medicine, North Shore Medical Center, Salem, Massachusetts, USA

*Olalekan Akanbi and Adeyinka C. Adejumo contributed equally to the writing of this article.

Correspondence to Olalekan Akanbi, MD, MPH, Department of Internal Medicine, Division of Hospital Medicine, University of Kentucky College of Medicine, 800 Rose Street, Lexington, Kentucky 40536, USA Tel: +1 312 330 6420; fax: +1 859 257 3873; e-mail: oakanbi1@gmail.com

Received January 26, 2018

Accepted May 9, 2018

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