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• W4316085174 abstract "Introduction: Helicobacter pylori is a frequent cause of chronic gastritis, peptic ulcer disease, and gastric cancer worldwide. In patients with cirrhosis, H. pylori is associated with an increased risk of portal vein thrombosis, hepatocellular carcinoma, and hepatic encephalopathy. This study aims to evaluate the impact of H. pylori on cirrhosis complications and inpatient outcomes in the US population. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019 for hospitalizations with a primary diagnosis of cirrhosis. We assessed demographics, in-hospital mortality, and complications of cirrhosis in patients with H. pylori and compared them to cirrhosis patients without H. pylori. We adjusted outcomes for potential confounders using multivariable logistic regression analysis. Results: Of 416,410 patients with cirrhosis, 990 (0.2%) had a concurrent diagnosis of H. pylori infection. Cirrhosis patients with H. pylori were more likely younger (54.25 vs. 57.18 years, p=0.01), of Hispanic race (36.4% vs. 18.6%, p< 0.1), and of Black race (20.2% vs. 8.1%, p< 0.1). H. pylori patients were more likely in the bottom quartile of median household income (48.17% vs. 34.66%, p< 0.01). H. pylori exposed patients had lower in-hospital mortality (0.51% vs 4.44%, p=0.007), but longer mean length of stay (6.97 days vs 5.75, p=0.002). H. pylori-exposed patients had a higher overall rate of cirrhosis-related complications (84.85% vs. 67.59%, p< 0.001), gastrointestinal bleed (48.48% vs. 27.34%, p< 0.001), and hepatorenal syndrome (70.71% vs. 46.99%, p< 0.001) which persisted on multivariable analysis. Rates of hepatic encephalopathy were initially higher in H. pylori-non-exposed patients (21.57% vs. 15.66%, p=0.04), which was corrected after adjusting potential confounders in multivariable analysis (Figure). Conclusion: In this study, H. pylori was associated with a higher length of stay in hospitalized cirrhotic patients but lower mortality. H. pylori patients had increased overall complications driven by gastrointestinal bleeding and hepatorenal syndrome. The lower mortality rate of H. pylori infection may partly be due to antibiotic use. Given the limitations of this retrospective cohort study, H. pylori as a causative factor for cirrhosis complications cannot be inferred with certainty. However, further studies are warranted to help elucidate the associations between H. pylori and cirrhosis complications. Eradicative therapy for H. pylori may be beneficial in select patients with Cirrhosis. (Table)Figure 1.: Odds of Complications in Cirrhosis Patients with H. pylori Infection Unadjusted and adjusted odds ratios* for overall complications, in-hospital mortality, gastrointestinal bleed, encephalopathy, hepatorenal syndrome and spontaneous bacterial peritonitis (SBP). *Adjusted for age, race, female, hypertension, diabetes, hyperlipidemia, heart failure, CKD stage 3 or greater, alcohol use disorder, coronary artery disease. Table 1. - Baseline characteristics Overall (%)(N= 416,410) Helicobacter Pylori Absent (%)(N= 415,420) Helicobacter Pylori Present (%)(N= 990) P-value Cirrhosis Mean Age, (Mean ± Standard error) (Years) 57.17 (57.07 - 57.27) 57.18 (57.08 - 57.28) 54.25 (52.55 - 55.95) 0.001 Age (years) 0.01 18-49 24.73 24.71 33.84 50-64 49.61 49.61 47.47 65-74 17.83 17.84 12.12 >= 75 7.84 7.84 6.57 Gender 0.028 Male 63.13 63.11 70.71 Female 36.87 36.89 29.29 Race < 0.001 White 64.01 64.10 26.26 Black 8.13 8.10 20.20 Hispanic 18.62 18.58 36.36 Asian or Pacific Islander 1.72 1.71 5.56 Native American 1.50 1.50 2.53 Other 6.02 6.02 9.09 Comorbiditya Obesity 14.29 14.30 11.62 0.275 BMI < 20 2.71 2.71 3.54 0.578 Hypertension 49.70 49.71 42.42 0.042 Diabetes 30.10 30.12 24.75 0.108 Hypercholesterolemia 16.33 16.35 8.08 0.002 Heart failure 11.95 11.96 7.58 0.059 Valvular Disease 0.74 0.74 0.51 0.701 CKD stage 3 or more 12.92 12.94 6.06 0.004 Alcohol use disorder 48.56 48.53 61.11 < 0.001 Peripheral vascular disease 3.72 3.73 1.52 0.101 COPD 12.94 12.94 10.61 0.327 Stroke 0.58 0.59 0.00 0.295 CAD 12.19 12.21 7.07 0.028 Cardiomyopathy 2.28 2.28 2.53 0.818 Coagulopathy 0.86 0.86 0.00 0.219 Bleeding Disorder 42.48 42.48 41.92 0.873 Smoking 22.28 22.27 25.25 0.325 Cancer 7.70 7.70 6.06 0.389 Autoimmune Disease 2.06 2.06 1.01 0.298 Median household income category for patient's Zip Coded 0.0002 0-25 percentile 34.69 34.66 48.17 26-50 percentile 26.73 26.73 24.61 51-75 percentile 22.64 22.64 19.90 76-100 Percentile 15.94 15.96 7.33 Primary Payere Federal insurance 65.68 65.68 65.68 Private insurance 21.86 21.88 12.12 Other 3.22 3.22 5.56 Uninsured 9.06 9.05 15.66 Missing 0.17 0.17 0.00 Hospital characteristics Hospital region 0.013 Northeast 16.76 16.76 17.17 Midwest 19.27 19.27 19.19 South 43.00 43.02 33.84 West 20.97 20.95 29.80 Hospital bed sizef 0.025 Small 17.11 17.11 13.64 Medium 28.33 28.35 22.22 Large 54.56 54.54 64.14 Hospital teaching statusg < 0.001 Non-teaching 26.42 26.45 15.15 Teaching 73.58 73.55 84.85 Hospital location 0.066 Rural 5.51 5.52 2.53 Urban 94.49 94.48 97.47 Disposition < 0.001 Home 63.25 63.21 80.30 Facility/others 4.43 4.44 0.51 Died 32.32 32.35 19.19 Admission Type 0.446 Non-Elective 94.70 94.70 97.47 Elective 5.14 5.14 2.53 Missing 0.16 0.16 0.00 In-hospital mortality 4.43 4.44 0.51 0.007 Length of stay (Mean ± Standard error) (Days) 5.76 (5.68 -5.83) 5.75 (5.68 - 5.83) 6.97 (6.21 – 7.72) 0.002 Cost of care (Mean ± Standard error) (USD) 16547.22 (16031.09 - 17063.36) 16543.49 (16026.53 - 17060.45) 18106.18 (15947.94 - 20264.41) 0.160 Elixhauser Comorbidity Index for Mortality (Mean ± 95% Conf. Interval)h -1.86 (-1.91 to -1.81) -1.86 (-1.91 to -1.81) -1.77 (-2.51 to -1.03) 0.809" @default.
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• W4316085174 date "2022-10-01" @default.
• W4316085174 modified "2023-09-27" @default.
• W4316085174 title "S1404 Outcomes and Complications of Hospitalized Cirrhosis Patients With H. pylori Infection" @default.
• W4316085174 doi "https://doi.org/10.14309/01.ajg.0000862256.77650.f6" @default.
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