Trends and Outcomes of Gastrointestinal Bleeding Among Septic Shock Patients of the United States: A 10-Year Analysis of a Nationwide Inpatient Sample

Abdul Hasan Siddiqui; Moiz Ahmed; Tahir Muhammad Abdullah Khan; Saqib Abbasi; Saad Habib; Hafiz M Khan; Kartikeya Rajdev; Naureen Narula; Faraz Siddiqui

doi:10.7759/cureus.8029

Trends and Outcomes of Gastrointestinal Bleeding Among Septic Shock Patients of the United States: A 10-Year Analysis of a Nationwide Inpatient Sample

Cureus. 2020 May 8;12(5):e8029. doi: 10.7759/cureus.8029.

Authors

Abdul Hasan Siddiqui¹, Moiz Ahmed^{2

3}, Tahir Muhammad Abdullah Khan^{4

3}, Saqib Abbasi⁵, Saad Habib³, Hafiz M Khan⁶, Kartikeya Rajdev⁷, Naureen Narula⁸, Faraz Siddiqui⁹

Affiliations

¹ Pulmonary and Critical Care Medicine, University of Illinois Urbana Champaign, Champaign, USA.
² Gastroenterology, Icahn School of Medicine at Elmhurst Hospital Center, Elmhurst, USA.
³ Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, USA.
⁴ Internal Medicine, Marshfield Medical Center, Marshfield, USA.
⁵ Hematology/Oncology, Staten Island University Hospital/Northwell Health, Staten Island, USA.
⁶ Gastroenterology and Hepatology, Guthrie Medical Group/Robert Packer Hospital, Sayre, USA.
⁷ Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, USA.
⁸ Pulmonary and Critical Care Medicine, Staten Island University Hospital/Northwell Health, Staten Island, USA.
⁹ Pulmonary and Critical Care Medicine, Robert Packer Hospital, Sayre, USA.

Abstract

Introduction Gastrointestinal bleeding (GIB) complicating septic shock (SS) presents a therapeutic challenge in intensive care units. Large-scale data regarding utilization, length of stay, and cost outcomes of this association are lacking. Methods We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2003 to 2012, and identified all adult patients aged ≥18 years hospitalized for SS by the International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code for SS and GIB. We compared the baseline characteristics and outcomes among patients with SS plus GIB to patients with SS without GIB. Results The weighted sample size from 2003 to 2012 was 119,684 admissions for SS. Among them, 6,571 (5.4%) patients were found to have a GIB. The mean age of the SS population with and without GIB was (mean/standard error of mean) [70.85 (0.43) vs. 67.43 (0.13) P < 0.001, respectively]. The incidence of GIB over the course of 10 years has remained stable; however, the mortality associated with GIB among SS patients is found to be declining especially from 2008 (59.2%) to 2012 (45.1%) (P < 0.01). Patients with SS and GIB compared to patients with SS and no GIB were found to have a longer length of stay [20.56 (0.61) vs. 15.76 (0.13) P < 0.001], higher mortality [54% vs. 45% P < 0.001], and higher admission costs in United States dollar ($) (mean/SEM) [$192,524.89 (7,378.20) vs. $142,688.55 (1,336.65) P < 0.001]. Univariate analysis demonstrated that comorbid conditions like peptic ulcer disease and cirrhosis had significant odds ratios {1.56 and 1.709, P = 0.016 and 0.046 respectively} for the occurrence of GIB with SS. Gastroesophageal reflux disease was found to be associated with a lower incidence of GIB [odds ratio: 0.57, P = 0.0008]. The cause of sepsis (pneumonia, urinary tract infection, or abdominal infections) was not a significant distinguishing factor for the incidence of GIB in SS. Conclusion GIB continues to affect the patients with SS admitted in intensive care units in the United States. We found an incidence of 5.4% of GIB in patients with SS, and it was associated with worse outcomes.

Keywords: coagulopathy; gastrointestinal bleeding; hemorrhage; icu; mortality; nationwide inpatient sample; sepsis; septic shock.