The Impact of Inflammatory Bowel Diseases on the Outcomes of Patients Admitted With Acute Viral Hepatitis: A 2016-2019 Nationwide Analysis

Abstract

INTRODUCTION Inflammatory bowel diseases (IBD) are thought to be caused by a dysregulated immune response in the digestive tract, amongst other factors (environmental, genetic predisposition, microbiota). Data on acute viral hepatitis (AVH) infection outcomes in patients with underlying IBD are scarce. We aimed to investigate the relationship between IBD and outcomes of patients with AVH. METHODS This is a retrospective longitudinal study of patients admitted with a primary diagnosis of AVH (A,B,C,D,E). We retrieved data from the Nationwide Inpatient Sample (NIS) databases from the years 2016 to 2019 using ICD-10 CM codes for AVH. Multivariate logistic regression analysis was performed in patients with IBD to estimate the effect of IBD on the primary outcomes of mortality, hospital utilization, and acute hepatitis complications, adjusted for patient and hospital confounders. A T-Test and Chi Square test were performed to compare baseline characteristics in patients admitted for AVH with and without a secondary diagnosis of IBD. We used STATA® Version 17.0 Software (STATACORP, TEXAS, USA) for analysis. The p-value was set at p < 0.05 for statistical significance. RESULTS A total of 47614 adult patients with a primary diagnosis of AVH were identified; four hundred twenty five (0.9%) had a secondary diagnosis of IBD. Most were middle-aged (mean age: 44 years), male (53%) white (78%), and were admitted in large sized (51%) and teaching hospitals (68%). There was no statistically significant change in the length of stay or total healthcare cost associated with the presence of IBD. Having IBD was associated with no change in the risk of fulminant hepatitis (OR = 0.55, p= 0.262, CI: 0.19 - 0.55), hypoglycemia (OR = 1.14, p= 0.904, CI: 0.13 - 9.56), thrombocytopenia (OR = 0.46, p= 0.209, CI: 0.14 - 1.53), and coagulopathy (OR = 1.22, p= 0.781, CI: 0.29 - 5.12). No case of mortality, hepatorenal syndrome or liver transplant was reported. DISCUSSION Despite the fact that IBD is associated with a dysregulated immune response in the digestive tract, our study showed that the presence of IBD in patients affected by acute viral hepatitis does not carry a significant impact on the outcomes of IBD (hospital utilization, morbidity, mortality). Broader studies are required to establish an association between IBD and AVH outcomes.