P1579 - Outcomes and Burden of Fistulizing Crohn’s Disease Admitted With Acute Kidney Injury

Ji Seok Park, MD, MPH, CNSC¹, Miguel Salazar, MD, CNSC¹, Mohamed Tausif Siddiqui, MD¹, Gianina Flocco, MD², Donald F. Kirby, MD, CNSC, CPNS, FACG¹, Douglas L. Seidner, MD, CNSC, FACG^1
1Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Foundation, Shaker Heights, OH

Introduction: Crohn’s disease (CD) has detrimental effects on kidney function such as acute kidney injury (AKI), due to infection, nephrolithiasis and volume depletion. Impaired water, Na⁺, and Cl^- absorption in the colon are common in this group of patients. The presence of fistulizing disease can significantly worsen the severity of AKI, as it predisposes to malabsorption, infection and malnutrition. Our aim of the study was to compare hospital outcomes and healthcare burden of AKI in patients who had fistulizing CD vs non-fistulizing CD.

Methods: A retrospective cohort study of the 2016-2017 National Inpatient Sample (NIS) database, using ICD10-CM/PCS codes was done to identify patients discharged with a primary diagnosis of AKI and those with a secondary diagnosis of fistulizing and non-fistulizing CD. Primary endpoint was in-hospital mortality. Secondary endpoints were length of stay (LOS), mechanical ventilation, sepsis, and hospital related charges. Multivariate regression analysis models to adjust for patient and hospital characteristics were performed for both primary and secondary outcomes.

Results: Of 14,249 patients with AKI and CD, 2.4% (345) had fistulizing disease. These patients more likely to be younger (63.1 years vs 59.2 years; P< 0.01), live in the southern US (40.5% vs 53.6%; P=0.03) and have less comorbidity burden as per Charlson score (20.5% vs 30.4%; P=0.04). They were more likely to have severe protein caloric malnutrition (15.4% vs 35.7%; P< 0.01), vitamin B12 deficiency (3.0% vs 7.3%; P< 0.01), hypokalemia (26.1% vs 39%; P< 0.01), hypovolemic hyponatremia (28.4% vs 43.5%; P< 0.01), to require transfusion of blood products (6.3% vs 15.9%; P< 0.01) and central parenteral nutrition (1.2% vs 4.4%; P=0.02). On multivariate regression analysis, we found a higher burden with fistulizing disease; higher LOS [1.25 days; (P< 0.01)], and overall hospitalization costs [$2,585; (P=0.03)]. No significant difference was found in hospital mortality, total charges and inpatient outcomes.

Discussion: Fistulizing CD appears to increase healthcare burden and duration of hospital stay in patients admitted with AKI, however is not associated with worse outcomes including in-hospital mortality.



Disclosures:


Ji Seok Park, MD, MPH, CNSC¹, Miguel Salazar, MD, CNSC¹, Mohamed Tausif Siddiqui, MD¹, Gianina Flocco, MD², Donald F. Kirby, MD, CNSC, CPNS, FACG¹, Douglas L. Seidner, MD, CNSC, FACG¹. P1579 - Outcomes and Burden of Fistulizing Crohn’s Disease Admitted With Acute Kidney Injury, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.