P0940 - Investigating the Effects of Hemochromatosis in Septic Patients With Cirrhosis Using National Inpatient Sample Analysis Data from 2016 to 2020

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Het Patel, DO

St. Luke's University Health Network
Bethlehem, PA

Het Patel, DO¹, Zarian Prenatt, DO¹, Hammad Liaquat, MD²
¹St. Luke's University Health Network, Bethlehem, PA; ²St. Luke's University Health Network, Bethlehem, PA

Introduction: Iron has been shown to be a pathogen promoting nutrient and thought to be the reason our bodies release hepcidin in situations of inflammation to inhibit iron release and decreases intestinal iron absorption. This idea also raised debate on the possible adverse effects of iron infusion in the setting of acute bacterial infection. This raises the question of how this affects patients with hemochromatosis who are genetically at risk for iron overload. The aim of this study is to investigate the risk of bacterial infections in patients with hemochromatosis.

Methods: This is a retrospective cohort study using National Inpatient Sample data including adults hospitalized between 2016 and 2020 with sepsis and liver cirrhosis. The primary outcomes measured were infections at different sites in patients with and without hemochromatosis. The secondary outcome measured were inpatient complications commonly associated with severe sepsis. Statistical analyses were all performed using STATA software.

Results: A total of 528,500 patients met our inclusion criteria of which 60.1% were male, 63.3% were Caucasian, and 2,700 had a history of hemochromatosis. Patients with hemochromatosis were at increased risk of DIC (OR=1.552; 95% Cl 1.043-2.310), SBP (OR=1.362; 95% Cl 1.054-1.760), and necrotizing pancreatitis with infection (OR=2.899; 95% Cl 1.075-7.822). Patients with hemochromatosis were at decreased risk for COPD exacerbation with infection (OR=0.552; 95% CI 0.340-0.896). Patients with hemochromatosis did not have statistically significant risk (p >0.05) of infections including cellulitis, bacterial colitis, bacterial pneumonia, surgical site infection, UTI, and pyelonephritis or serious inpatient complications including respiratory failure, intubation, mechanical ventilation, vasopressors, shock, ICU level of care, or mortality.

Discussion: Of the different infections assessed, patients with hemochromatosis were only at increased risk of SBP and necrotizing pancreatitis with infection which may be secondary to predisposing liver and pancreas damage. These patients did, however, have an increased risk of DIC which is a known complication of gram-negative bacteremia. Interestingly, patients with hemochromatosis were less likely to develop COPD exacerbation with infection which may account for a protective factor against viral infection since there was not a statically significant association with bacterial pneumonia. Our data also did not show any increased risk of the studied inpatient complications.

	Cirrhotic with Sepsis With Hemochromatosis (n = 2700)	Cirrhotic with Sepsis Without Hemochromatosis (n = 525800)	p-value
Demographics:
Mean Age, years	60.0	60.4	0.400
Gender, n Male Female	1775 (65.7%) 925 (34.3%)	316010 (60.1%) 209745 (39.9%)	0.008
Race, n White Black Hispanic Asian or Pacific Islander Native American Other	2165 (80.2%) 155 (5.7%) 155 (5.7%) 60 (2.2%) 5 (0.2%) 80 (3.0%)	332460 (63.2%) 50715 (9.7%) 89875 (17.1%) 13165 (2.5%) 10645 (2.0%) 15905 (3.0%)	< 0.001 0.003 < 0.001 0.673 0.002 0.932
Mean Length of Stay, days	9.4	9.6	0.529
Charlson Comorbidity Index, n 1 2 3 4 5 or more	315 (11.7%) 225 (8.3%) 660 (24.4%) 660 (24.4%) 940 (34.8%)	47265 (9.0%) 52095 (9.9%) 12070 (2.3%) 85970 (16.4%) 220200 (41.9%)	0.033 0.226 0.390 0.006 0.001
Infections:
SBP, n	330 (12.2%)	48765 (9.3%)	0.018
Necrotizing Pancreatitis with Infection, n	20 (0.7%)	1350 (0.3%)	0.028
Cellulitis, n	250 (9.3%)	58830 (11.2%)	0.161
Bacterial Colitis, n	60 (2.2%)	13360 (2.5%)	0.638
Bacterial Pneumonia, n	700 (25.9%)	140725 (26.8%)	0.662
Surgical Site Infection, n	105 (3.9%)	16010 (3.0%)	0.253
COPD Exacerbation with Infection, n	85 (3.2%)	29250 (5.6%)	0.015
UTI, n	520 (19.3%)	103800 (19.7%)	0.780
Pyelonephritis, n	30 (1.1%)	4905 (0.9%)	0.667
Inpatient Complications:
DIC, n	135 (5.0%)	17245 (3.3%)	0.029
Respiratory Failure, n	905 (33.5%)	172420 (32.8%)	0.716
Intubation, n	575 (21.3%)	111180 (21.1%)	0.930
Mechanical Ventilation, n	685 (25.4%)	130420 (24.8%)	0.759
Vasopressors, n	225 (8.3%)	39640 (7.5%)	0.478
Shock, n	700 (25.9%)	137800 (26.2%)	0.880
ICU, n	745 (27.6%)	146045 (27.8%)	0.924
Mortality, n	655 (24.3%)	116380 (22.1%)	0.238

Table: Demographics, infections, and inpatient complications of patients with cirrhosis and sepsis comparing a population with hemochromatosis and a population without hemochromatosis from 2016 to 2020.
Abbreviations: SBP = Spontaneous Bacterial Peritonitis, COPD = Chronic Obstructive Pulmonary Disease, UTI = Urinary Tract Infection, DIC = Disseminated Intravascular Coagulation, ICU = Intensive Care Unit

Disclosures:

Het Patel indicated no relevant financial relationships.

Zarian Prenatt indicated no relevant financial relationships.

Hammad Liaquat indicated no relevant financial relationships.

Het Patel, DO¹, Zarian Prenatt, DO¹, Hammad Liaquat, MD². P0940 - Investigating the Effects of Hemochromatosis in Septic Patients With Cirrhosis Using National Inpatient Sample Analysis Data from 2016 to 2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.