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P217. Inflammatory bowel disease is associated with higher mortality and length of hospitalisation in patients undergoing hematopoietic stem cell transplantation: a nationwide study

M. Dave1, K. Mehta2, 1Mayo Clinic, Gastroenterology and Hepatology, Rochester, United States, 2Drexel University School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, United States

Background

National outcomes data for hospitalizations for hematopoietic stem-cell transplantation (HSCT) in patients with underlying Inflammatory Bowel Disease (IBD) in United States (US) are unknown.

Methods

We did a cross sectional study-utilising data from Nationwide Inpatient Sample (NIS) from the years 2003–2010 for determining outcomes in IBD (Crohn's and ulcerative colitis) patients who underwent HSCT for an indication other than IBD. NIS is the largest all-payer database of inpatient care that collects annual data from about 1,000 hospitals that approximate a 20% stratified sample of US hospitals, and provides a national representative sample of US population. International Classification of Diseases, 9th Revision, Clinical Modification codes 555.X, 556.X and 41.0X (procedure code) were used to identify patients with CD, UC and HSCT. Nationally representative estimates were obtained from weighted NIS data. We compared the outcomes in IBD patients who underwent HSCT (HSCT-IBD) to matched HSCT patients without IBD. Matching was done for age (±5 years), sex, Charlson comorbidity index (±3 points), indication for HSCT, type of HSCT (allogeneic, autologous, unspecified) and year of HSCT (±1 year).

Results

Over the years 2003–2010 NIS sampled over 63,865,171 hospital admissions and contained data on 22,133 patients without IBD and 115 with IBD who underwent HSCT. After applying sample weights, these represented 111,568 and 584 hospitalisations for HSCT in non-IBD and IBD patients respectively. The mean age of HSCT-IBD patients was 48.8 years, 79.8% were whites, 43.5% were females, 49.6% had UC and 50.4% had CD. A multivariate logistic regression analysis for inpatient mortality for HSCT revealed IBD (OR 2.38, 95% CI: 1.82–3.11), female gender (OR 1.11, 95% CI: 1.05–1.17) and higher Charlson comorbidity index (OR 1.12, 95% CI: 1.10–1.14) as predictors of mortality (p < 0.001). Older age [OR 0.991 (95% CI, 0.989–0.992; p < 0.001)] was inversely associated with mortality. After matching, HSCT-IBD patients (weighted n = 529) had higher inpatient mortality (10.34% vs 5.97%, p < 0.001), longer length of hospitalisation (30.4 vs 26.1 days, p = 0.018) and showed a trend towards higher mean costs of hospitalisation ($290,132 vs $247,752, p = 0.07) as compared to non-IBD patients (weighted n = 3097) who underwent HSCT.

Conclusion

Patients with IBD who underwent HSCT (indication other than IBD) have higher mortality and length of hospitalisation associated with HSCT.