ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2996

Intestinal Pseudo-Obstruction in Patients with Systemic Sclerosis: An Analysis of the Nationwide Inpatient Sample

Antonia Valenzuela1, Shufeng Li2, Laren Becker3, Nielsen Fernandez-Becker3, Dinesh Khanna4, Linda Nguyen3 and Lorinda Chung5, 1Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, 2Dermatology, Stanford University School of Medicine, Palo Alto, CA, 3Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, CA, 4University of Michigan Health System, Ann Arbor, MI, 5Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics III: Updates in Predictors and Outcomes in Systemic Sclerosis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Intestinal pseudo-obstruction accounted for 3.7% of hospitalizations of patients with systemic sclerosis (SSc), and led to death in 10% of patients in a previous dual-center study. We aimed to determine the prevalence of intestinal pseudo-obstruction in hospitalized patients with SSc in a large US national database and to compare outcomes between patients with intestinal pseudo-obstruction and SSc, patients with intestinal pseudo-obstruction secondary to other causes, and SSc patients without intestinal pseudo-obstruction.

Methods: This is a case-control study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) for the period 2002–2011. We included patients using the previously validated International Classification of Diseases-Clinical Modification-9 code 710.1 for SSc in combination with codes for intestinal pseudo-obstruction. We used multivariate logistic and linear regression, adjusting for potential confounders and comorbidities using a modified Charlson comorbidity index, to determine the risks for surgical procedures (total or partial resection of small or large intestine), use of parenteral nutrition, and in-hospital mortality, and to estimate the length of stay in SSc patients compared with controls.

Results: A total of 193610 SSc hospitalizations occurred in the US between 2002 and 2011, of which 5.4% (n=10386) were associated with a concurrent intestinal pseudo-obstruction diagnosis (cases). The mean age of this group was 62.5±0.4 years, 81% were female, and 55% Caucasian. In-hospital mortality was 7.3%, mean length of stay was 9.3±0.3 days, 13.5% received parenteral nutrition, and 6% underwent surgical procedures (Table 1). In multivariate analyses, cases were more likely to die during the inpatient stay and to receive parenteral nutrition than patients with idiopathic intestinal pseudo-obstruction (control group 1), patients with intestinal pseudo-obstruction and diabetes (control group 2), and SSc patients without intestinal pseudo-obstruction (control group 3). Cases had longer in-hospital stay than control groups 2 and 3, and were less likely to undergo surgical procedures than control groups 1 and 2. (Table 2)

Conclusion: The prevalence of intestinal pseudo-obstruction in patients with SSc was 5.4% in this large US-based hospitalization database. SSc patients with intestinal pseudo-obstruction are more likely to die and to receive parenteral nutrition than patients with intestinal pseudo-obstruction secondary to other causes and SSc patients without intestinal pseudo-obstruction.

Table 1

Cases

n (%)

 Controls 1

n (%)

 Controls 2

n (%)

 Controls 3

n (%)
Length of stay (days ± SD)

 9.3 ± 0.3

 8.4  ± 0.1

 8.3 ± 0.1

 6.0 ± 0.1
In-hospital mortality

757 (7.3)

 200154 (5.1)

 54322 (4.7)

 9394 (5.1)
Surgical procedures

 620 (6)

 307976 (7.8)

 89292 (7.7)

 1088 (0.6)
Parenteral nutrition

1397 (13.5)

 243752 (6.2)

 66665 (5.7)

 3765 (2.1)


Table 2

In-hospital mortality

 Parenteral nutrition

 Surgical Procedures

 Length of stay
OR

 95%CI

 p-value

 OR

 95%CI

 p-value

 OR

 95%CI

 p-value

 b

 95%CI

 p-value
Cases vs Controls 1

 1.3

 1.02-1.52

 0.029

 2.3

 1.95-2.63

 <.0001

 0.8

 0.68-0.98

 0.66

 0.2

 -0.26-0.72

 0.355
Cases vs controls 2

 2.4

 1.99-2.8

 <.0001

 2.8

 2.39-3.22

 <.0001

 0.8

 0.67-0.96

 0.017

 1.4

 0.88-1.85

 <.0001
Cases vs control 3

 1.3

 1.12-1.60

 0.002

 7.4

 6.25-8.66

 <.0001

 10.9

 8.7-13.7

 <.0001

 3.2

 2.74-3.71

 <.0001
OR=Odds ratios, b= b-coefficient, Cases= patients with SSc and intestinal pseudo-obstruction, Controls 1=patients with idiopathic intestinal pseudo-obstruction, Controls 2=patients with intestinal pseudo-obstruction and diabetes, Controls 3=patients with SSc without intestinal pseudo-obstruction. All multivariate model included age, gender, race and modified Charlson comorbidity index

Disclosure:

A. Valenzuela,
None;

S. Li,
None;

L. Becker,
None;

N. Fernandez-Becker,
None;

D. Khanna,

NIH/NIAMS funding,

2;

L. Nguyen,
None;

L. Chung,

Gilead Science,

9.

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