Primary sclerosing cholangitis hospitalizations in the United States: characteristics and predictors of clinical outcomes

Khaled Elfert; Hazem Abosheaishaa; Tarek Aboursheid; Azizullah Beran; Mohamed Ahmed; Rami Musallam; Ahmad Al-Taee

doi:10.1080/08998280.2023.2254196

Primary sclerosing cholangitis hospitalizations in the United States: characteristics and predictors of clinical outcomes

Proc (Bayl Univ Med Cent). 2023 Sep 14;36(6):700-704. doi: 10.1080/08998280.2023.2254196. eCollection 2023.

Authors

Khaled Elfert¹, Hazem Abosheaishaa², Tarek Aboursheid³, Azizullah Beran⁴, Mohamed Ahmed⁵, Rami Musallam⁶, Ahmad Al-Taee⁷

Affiliations

¹ Department of Internal Medicine, SBH Health System, New York, New York, USA.
² Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens, New York, USA.
³ Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA.
⁴ Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA.
⁵ Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
⁶ Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
⁷ Department of Gastroenterology, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.

Abstract

Background: Primary sclerosing cholangitis (PSC) is a chronic progressive disease that primarily affects the medium and large biliary ducts.

Methods: This study investigated the baseline characteristics and predictors of clinical outcomes among hospitalized patients with PSC in the US. Using the National Inpatient Sample database from 2018 to 2020, we included adults with a principal diagnosis of PSC.

Results: Our study included 2585 adult hospitalizations. The prevalence of cirrhosis, ulcerative colitis (UC), Crohn's disease (CD), and cholangiocarcinoma among hospitalized PSC patients was 44.5%, 32.3%, 13.15%, and 5.2%, respectively. Over a third of patients (38.1%) underwent endoscopic retrograde cholangiopancreatography (ERCP). UC, CD, cholangiocarcinoma, and autoimmune hepatitis had no impact on mortality, length of stay, or ERCP utilization. Interestingly, individuals of Asian/Pacific Islander ethnicity had higher odds of undergoing ERCP compared to White ethnicity (odds ratio 4.67, 95% confidence interval 1.25-17.4). Conversely, patients with cirrhosis and liver transplant recipients were less likely to undergo ERCP.

Conclusion: This is the first nationwide study to assess the clinical characteristics and outcomes of hospitalized patients with PSC. It highlights various factors associated with increased utilization of ERCP, longer length of stay, and increased inpatient mortality. Further research is warranted to explore these associations.

Keywords: ERCP; liver transplantation; primary sclerosing cholangitis.