P0707 - Characteristics and Outcomes of Patients With Splenic Infarction With and Without Cirrhosis: Results From the National Inpatient Sample (2015-2017)

Subhash Garikipati, MD¹, Jashwanth Gaddam, MD¹, Kirtenkumar Patel, MD², Anush Vasikaran, MD¹, Hrishikesh Samant, MD^3
1Louisiana State University Health Sciences Center, Shreveport, LA; ²North Shore Medical Center, Manhasset, NY; ³Ochsner Medical Center, New Orleans, LA

Introduction: Splenic infarction (SI) is a condition that results from occlusion of the splenic artery by thromboemboli, mostly seen in patients with hematological or cardiovascular disease. Evidence has shown SI to be a rare cause of cirrhosis and portal hypertension. Spontaneous SI in cirrhosis has been hypothesized to arise from congestive splenomegaly which leads to increased oxygen requirements by the spleen and is compounded by the decreased oxygen carrying capacity of the blood due to anemia of chronic disease. We conducted a study to investigate the characteristics/outcomes of patients with SI with and without concomitant cirrhosis.

Methods: We analyzed the National Inpatient Sample 2015-2017 to determine national estimates of characteristics such as age, gender, race, insurance type, comorbidities and outcomes such as in-hospital mortality, length of stay, hospitalization costs, and complications for both SI patients with cirrhosis and without cirrhosis. SAS 9.4 was used to run statistical analysis.

Results: A total of 3,675 patients with SI and cirrhosis and 37,055 patients with SI without cirrhosis were included for analysis. The group of patients with SI and cirrhosis were found to have significantly higher in-hospital mortality even when adjusted for age, race, gender, and comorbidities. (8% vs 6.4%) (See table 1) The cirrhosis group also had a higher risk of in-hospital complications such as dehydration/electrolyte disorders and septic shock. Comorbidities higher in the cirrhosis group included diabetes mellitus, solid tumors, coagulopathies, and anemias. (See table 1) Patients with cirrhosis were more likely to have an emergent admission when compared to patients without cirrhosis.

Discussion: Cirrhosis is a common cause of splenomegaly through mechanisms like portal congestion, altered hemodynamics, and inflammatory mediators which as a result can increase the risk for SI. Our study shows that patients with SI and cirrhosis are likely to have higher in-hospital mortality than patients with SI due to other causes. This is likely due to systemic effects of cirrhosis and the potential for drastic decompensation in such patients. This is further reflected in the profile of comorbidities in patients with cirrhosis who were found to be more likely to have anemia, coagulopathy, and fluid/electrolyte disturbances. Further prospective clinical studies are needed to identify patients who are at high risk for development of SI and would potentially benefit routine screening or surveillance.

Outcomes	Splenic Infarction with Liver Cirrhosis	Splenic Infarction without Liver Cirrhosis	P-value
In-hospital mortality	8%	6.4%	< .0001
	Adjusted odds ratio1 1.30(1.10 – 1.53)		0.001
Length of stay, days (Median,IQR)	5(3 - 9)	5(3 - 10)	0.04
Total hospitalization cost, $ (Median,IQR)	13018(7260 - 26811)	13410(7192 - 28551)	0.30
In- Hospital Complications
Dehydration and electrolyte disorders	52.8%	42.7%	< .0001
Septic Shock	6.7%	5.8%	0.05
Ascites	27.3%	6.9%	< .0001
Peritonitis	11.3%	3.6%	< .0001
Acute Liver Failure	4.9%	1.7%	< .0001
1Adjusted for age, race, gender, Elixhauser Comorbidities, primary payer, hospital teaching status.

Table: Table 1


Disclosures:
Subhash Garikipati indicated no relevant financial relationships.
Jashwanth Gaddam indicated no relevant financial relationships.
Kirtenkumar Patel indicated no relevant financial relationships.
Anush Vasikaran indicated no relevant financial relationships.
Hrishikesh Samant indicated no relevant financial relationships.


Subhash Garikipati, MD¹, Jashwanth Gaddam, MD¹, Kirtenkumar Patel, MD², Anush Vasikaran, MD¹, Hrishikesh Samant, MD³. P0707 - Characteristics and Outcomes of Patients With Splenic Infarction With and Without Cirrhosis: Results From the National Inpatient Sample (2015-2017), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.