title: National trends and inpatient outcomes of inflammatory bowel disease patients with concomitant chronic liver disease.
abstract: BACKGROUND
  There is little information on the frequency of chronic liver disease among hospitalized patients with inflammatory bowel disease (IBD). In this study, we seek to define the common etiologies contributing to chronic liver disease among IBD patients and to identify potential risk factors predictive of increased mortality in this population.
  
  
  METHODS
  We analyzed the Nationwide Inpatient Sample from 1988 to 2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes.
  
  
  RESULTS
  From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has increased from 4.35 per 100,000 persons in 1988-2001 to 7.45 per 100,000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among IBD patients were: primary sclerosing cholangitis, unspecified chronic hepatitis, chronic hepatitis C, and nonalcoholic fatty liver disease. Compared to IBD patients without liver disease, there was more than a twofold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.7% vs. 1.3%, p < 0.01). The multivariate analysis showed that factors predictive of inpatient mortality include age >50, spontaneous bacterial peritonitis, ascites, hepatic encephalopathy, presence of cirrhosis, malnutrition, Clostridium difficile colitis, and hospital-acquired pneumonia.
  
  
  CONCLUSIONS
  There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease compared to IBD alone. Early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity.
authors.affiliation: Division of Gastroenterology and Hepatology, University of California-Irvine , Orange, CA , USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
authors.forename: Mohammad Mazen
authors.initials: MM
authors.lastname: Jamal
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001201:Ascites / Q000453:epidemiology; D002908:Chronic Disease; D016360:Clostridioides difficile; D003093:Colitis, Ulcerative / Q000401:mortality*; D003424:Crohn Disease / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology; D011014:Pneumonia / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: chronic liver disease; inflammatory bowel disease; primary sclerosing cholangitis