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Obesity does not increase in-hospital mortality among patients with upper GI hemorrhage

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HONOLULU — Among patients with upper gastrointestinal hemorrhage, obesity was found to be associated with increased ICU admissions, hemorrhagic shock and health care resource utilization, but not with increased in-hospital mortality, according to retrospective study data presented at ACG 2015.

“To our knowledge and to date no prior study has examined the impact of obesity on upper GI hemorrhage outcome,” Marwan S. Abougergi, MD, from Catalyst Medical Consulting, said during his presentation. “Therefore, our research objectives were to determine whether obesity is a negative prognostic factor among patients with upper gastrointestinal hemorrhage using a database that is representative of all hospitals in the U.S.”

Marwan S. Abougergi

To evaluate the impact of obesity on in-hospital mortality, other clinical outcomes and health care resource utilization among hospitalized adult patients with upper GI hemorrhage (UGIH), Abougergi and colleagues performed a retrospective cohort study of 132,545 emergent discharges with UGIH identified using the 2012 Nationwide Inpatient Sample database, 8.5% of whom were obese.

Overall, 1.93% of patients died from UGIH. Multivariable analysis adjusting for a variety of confounders showed a comparable risk for in-hospital mortality, surgery and radiologic intervention for obese patients compared with nonobese patients with UGIH. However, obesity was found to be significantly associated with the following outcomes among hospitalized patients with UGIH:

• More likely to have in-hospital endoscopy (adjusted OR = 1.31; 95% CI, 1.15-1.49);
• More likely to have endoscopic treatment (aOR = 1.29; 95% CI, 1.15-1.45);
• Less likely to have early endoscopy within 24 hours (aOR = 0.9; 95% CI, 0.82-0.99);
• More likely to have hemorrhagic shock (aOR = 1.31; 95% CI, 1.03-1.67);
• More likely to have ICU admission (aOR = 1.35; 95% CI, 1.07-1.7).

Furthermore, the adjusted mean additional length of stay for obese patients with UGIH was 0.42 (95% CI, 0.21-0.63) days and the adjusted mean additional total charges were $4,693 (95% CI, $2,458-$6,928; both comparisons, P < .01 compared with nonobese patients).

“Obesity is not associated with an increased in-hospital mortality among patients admitted with upper gastrointestinal hemorrhage, unlike in several other medical conditions,” but is associated with increased hemorrhagic shock and ICU admission, Abougergi said. “More frequent in-hospital endoscopies and endoscopic treatment performed for obese patients could potentially explain the similar in-hospital mortality. And finally, obesity is associated with an increase in health care resource utilization as measured by length of stay and total hospitalization charges.” – by Adam Leitenberger 

Reference:

Abougergi MS, et al. Abstract 7. Presented at: ACG; Oct. 19-21, 2015; Honolulu, HI.

Disclosures: The researchers report no relevant financial disclosures.