Abstracts S299
[558_B] Odds Ratios and 95% for upper and lower endoscopy findings using the training data set (N=419)
Characteristic Upper endoscopy positive for a cause of IDA
Unadjusted P-value Initial model
Age (years) 1.01 (0.99-1.03) 0.241 1.01 (0.99-1.03)
Male 1.49 (0.93-2.40) 0.095 1.42 (0.87-2.30)
African American 1.25 (0.77-2.07) 0.374
Laboratory
MCV 0.99 (0.97-1.01) 0.533
Transferrin Saturation 1.01 (1.00-1.02) 0.111 1.01 (0.99-1.02)
Ferritin 1.00 (1.00-1.00) 0.415
MCV*Male
Iron deficiency anemia - IDA, mean corpuscular volume – MCV
this gender interaction with MCV, it was not a good screening tool since it had a low AUC (45.8%,
95% CI: 32.6-59.0%).
Conclusion: Ferritin, TS and MCV levels do not seem to be good indicators of potential bleeding lesions
or cancer in patients undergoing GI endoscopy, even using different cut-off points. Gender and its inter-
action with MCV were identified as factors associated with colonoscopy findings. These observations
merit prospective evaluation.
559
The Incidence, Risk Factors and Impact of 30-Day Readmission of Patients With Upper
Gastrointestinal Hemorrhage on Mortality and Healthcare Resource Utilization: A Nationwide
Analysis
2017 Prgesidential Poster Award
Marwan Abougergi, MD1, Heather Peluso, DO2, Chebli Mrad, MD3, John Saltzman, MD4. 1Catalyst
Medical Consulting, Simpsonville, SC; 2University of South Carolina, Greenville, SC; 3Icahn School of
Medicine at Mount Sinai/Mount Sinai West, New York, NY; 4Brigham & Women's Hospital, Harvard
School of Medicine, Boston, MA
Introduction: We sought to determine the 30-day readmission rate of patients with non-variceal upper
gastrointestinal hemorrhage (NVUGIH) and its impact on mortality and healthcare utilization in the
United States using the largest national readmission database.
Methods: This is a cohort study using the 2014 National readmission Database. Discharges were
included if they were adults, urgent/emergent and had a principal ICD-9 CM code indicating
NVUGIH. A readmission was defined as the first admission to any hospital for any non-trauma
diagnosis within 30 days of the index admission. Same day admissions and discharges were excluded.
The primary outcome was 30-day readmission. Secondary outcomes were 30-day mortality rate, most
common reasons for readmission, readmission mortality rate and resource utilization (length of stay
and hospitalization total costs). Independent risk factors for readmission were identified using multi-
variate regression analysis.
Results: The number of admissions for NVUGIH was 232,931. The mean age was 65.5 years (65.2-
65.7) and 45% of patients were female. The all cause and NVUGIH-specific 30-day readmission
rates were 24.9% and 23.1%, respectively. The in-hospital and 30-day mortality rate were 1.9% and
2.4%, respectively. The in-hospital mortality rate for readmitted patients was 4.0%. The most com-
mon reasons for readmission are listed in Table 1. The most common 3 reasons for all-cause and
NVUGIH-specific readmission were rebleeding, septicemia and pneumonia, and gastric ulcer, duo-
denal ulcer and angiodysplasia, respectively. Table 2 shows the odds ratios of the various factors tested
as independent predictor of readmission. Independent predictors of readmission were female sex,
older age, low income, Medicaid, comorbidities, admission to high-volume and teaching hospitals,
and no upper endoscopy or endoscopic therapy during index hospitalization. The total hospital days
associated with readmission were 279,201 days, with a total healthcare in-hospital economic burden
of $6.68 billion.
Conclusion: The in-hospital and 30-day mortality for NVUGIH are 1.9% and 2.4%. The overall and
NVUGIH specific 30- day readmission rates are 24.9% and 23.1%. The in-hospital mortality increases
after readmission to 4.0% (p‹0.01) and healthcare in-hospital economic burden was $6.68 billion in 2014.
Readmission rates in patients with NVUGIH are high and are associated with an increase in both mortality
and resource utilization.
560
30-Day Unplanned Readmission Etiology, Cost, and Length of Stay for Upper Gastrointestinal
Hemorrhage versus Lower Gastrointestinal Hemorrhage Patients in the United States
Smit Patel, MD, MPH1, Shreyans Doshi, MD2, Neel Patel, MBBS3, Upenkumar Patel, MBBS, MPH4,
Chintan Rupareliya, MD, MHA5, Karan Amlani, MD6, Shantanu Solanki, MD7, Zinal Patel, MD8.
1
University of Connecticut School of Medicine, Hartford, CT; 2University of Central Florida College of
Medicine, Gainesville, FL; 3Florida International University, Herbert Wertheim College of Medicine,
Miami, FL; 4National University, Bellerose, NY; 5University of Missouri, Columbia, MO; 6Icahn School
of Medicine at Mount Sinai, New York, NY; 7New York Medical College at Westchester Medical Center,
Valhalla, NY; 8Winthrop University Hospital, Alberston, NY
Introduction: Gastrointestinal hemorrhage (GIH) is associated with a high morbidity and mortality in
the United States. The factors contributing to 30-day unplanned readmissions in upper gastrointestinal
hemorrhage (UGIH) and lower gastrointestinal hemorrhage (LGIH) are unclear. Our objective was to
identify specific readmission causes, associated costs, and the length of stay (LOS) due to unplanned
30-day readmissions in UGIH vs. LGIH.
© 2017 by the American College of Gastroenterology 
Lower endoscopy positive for a cause of IDA
P-value Unadjusted P-value Initial model P-value
0.253 0.99 (0.98-1.01) 0.408
0.156 1.93 (1.18-3.20) 0.009 541 (14-23616) <0.001
0.99 (0.60-1.65) 0.956
0.99 (0.97-1.01) 0.480 1.00 (1.00-1.00) 0.199
0.222 1.01 (0.99-1.02) 0.458
1.00 (1.00-1.00) 0.204 1.04 (1.00-1.08) 0.036
0.93 (0.89-0.98) 0.003
Methods: The National Readmission Dataset (NRD) from 2013, released by Healthcare Cost and Uti-
lization Project (HCUP), was used to obtain the data. HCUP is an agency for healthcare research and
quality, and NRD is one of the largest databases that collects samples of discharges from hospitals in
the United States, excluding rehabilitation and long-term acute care hospitals. Discharge weights were
used to generate national estimates. The patients with UGIH and LGIH were identified by primary
discharge diagnosis with ICD9-CM codes. The cost of readmission was then calculated by multiply-
ing total charges with the cost to charge ratio provided by HCUP. Using the statistical software SAS
version 9.4, survey procedures were implemented to adjust for stratified cluster design of NRD with
DOMAIN, STRATA, CLUSTER and WEIGHT statement. A P-value of less than 0.05 was considered
significant.
Results: The NRD contained 82,290 of UGIH (weighted N=185,107) and 133,114 of LGIH (weighted
N=300,920) index admissions in 2013. Etiologic trends for 30-day unplanned readmissions in UGIH vs.
LGIH were GI hemorrhage (17.5% vs. 14.6%), septicemia (6.7% vs. 6.0%), non-hypertensive congestive
heart failure (6.1% in both), pneumonia (3% vs. 2.7%), and anemia (3.6% vs. 2.7%). The estimated cost of
unplanned 30-day readmissions was $3.5 billion in UGIH vs. $5.3 in LGIH. The estimated index admis-
sion cost of UGIH was $1.9 billion vs. $2.7 billion in LGIH. The average length of stay (LOS) during
readmission was 5.9 days in UGIH vs. 4.2 days in LGIH.
Conclusion: The etiologies for the 30-day unplanned readmission were similar for both UGIH and
LGIH. However, the 30-day unplanned readmission costs were higher for LGIH than UGIH. The aver-
age length of stay in the hospital was longer for UGIH than for LGIH. Further research will be needed
to identify causes and develop strategies to reduce overall number of the readmissions from preventable
causes.
561
HIV Infection: Does It Affect Outcomes of Gastrointestinal Bleeding?
Elizabeth Brindise, DO, Aneesh Kuruvilla, DO, Rogelio Silva, MD. University of Illinois at Chicago,
Advocate Christ Medical Center, Oak Lawn, IL
Introduction: Gastrointestinal (GI) bleeding is a relatively infrequent complication seen in patients
with HIV infection. Beyond the traditional risk factors associated with HIV infection, bleeding may
result from conditions completely unrelated. The effect of HIV infection in outcomes of GI bleeding is
currently unknown. We sought to evaluate contemporary outcomes and complications of GI bleeding in
patients with co-morbid HIV infection.
Methods: The study population was derived from the HCUP- National Inpatient Sampling database for
the years 2007-2013. ICD-9 codes were used to identify patients with GI bleeding. In-hospital all-cause
mortality, total cost of hospitalization, mean length of stay and outcomes rates were assessed. Propensity
score matching was used to adjust for baseline confounders.
Results: Among 5,850,728 admissions with GI bleeding during the study period, 46,683 (0.8%) had a
history of comorbid HIV infection. HIV patients were more likely to be younger, male, with a history of
hepatitis, alcohol related disorder, chronic renal failure, pancreatic disease, liver and biliary disease and
coagulation and hemorrhagic disorders (P<0.0001). In hospital all-cause mortality, length of stay, cost of
hospitalization and rates of acute kidney injury, acute stroke and blood transfusions were significantly
higher in the HIV patient cohort. These statistically significant differences persisted after propensity score
matching analysis. (Figure 1).
Conclusion: Co-morbid HIV infection is associated with increased in hospital all-cause mortality, length
of stay, cost of hospitalization and rates of acute kidney injury, acute stroke and blood transfusions in
patients presenting with GI bleeding.
562
The Impact of Pro-hemorrhagic Drugs on Predictability of the Glasgow-Blatchford, Rockall and
Full Rockall Risk Scoring Systems
Damir F. Muhovic, MD1, Brigita Smolovic, PhD, MD2, Velimir Milosevic, PhD, MD2, Olivera Sekulic, MSc,
MD2, Zlata Kovacevic, MD1, Sanja M. Vucetic, MD1, Srdjan Djuranovic, PhD, MD3. 1Clinical Center of
Montenegro, Podgorica, Opstina Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro;
Clinical Center of Montenegro, Podgorica, Opstina Podgorica, Montenegro; 3Faculty of Medicine, Univer-
sity of Belgrade; Clinical Center of Serbia, Belgrade, Serbia
Introduction: The three commonly used scoring systems to predict clinical outcomes for patients
with nonvariceal upper gastrointestinal bleeding (NVUGIB) are: Rockall score (RS), full Rockall
score (FRS) and Glasgow-Blatchford score (GBS). According to the current guidelines, GBS is
used to identify patients with NVUGIB who will need some kind of a clinical intervention, whereas
FRS is used to predict the risk of rebleedinig and mortality. The aim of our study is to compare
The American Journal of GASTROENTEROLOGY
S300 Abstracts

[558] Receiver operator characteristic curves of ferritin, transferrin saturation (TSAT) and mean corpuscular volume (MCV) as screening tools for gastrointestinal (GI) malignancy
and any lesions potentially accountable for iron deficiency anemia (upper endoscopy - EGD; lower endoscopy - Colonoscopy).

predictiveness of GBS, RS and FRS for clinical outcomes among patients with NVUGIB who used
pro-hemorrhagic drugs.
[559_A] Most common reasons for readmission
Methods: A retrospective analysis included 301 patients with NVUGIB. All patients were divided into
two groups: study group with patients who used pro-hemorrhagic drugs: non-steroid anti-inflammatory
All-cause 30-day readmission NVUGIH-specific 30-day readmission drugs (NSAID), acetylsalicylic acid (ASA), other antiplatelet drugs (APD), oral anticoagulant drugs
(OAC) and corticosteroids (CS), and control group with patients who did not use the pro-hemorrhagic
Non-specific gastrointestinal hemorrhage Gastric ulcer
drugs. We divided all clinical outcomes into two groups: unwanted outcomes (UO) – endoscopic inter-
Septicemia Duodenal ulcer vention (EI) and blood transfusion (BT); and severe unwanted outcomes (SUO) – rebleeding (RB), surgi-
cal intervention (SI) and 30-day mortality (M). GBS, RS and FRS were calculated for each patient. The
Pneumonia Angiodysplasia of stomach and duodenum performance of these scores for predicting clinical outcomes was assessed by calculating the area under
the receiver-operating characteristic curve (AUC)
Acute renal failure Hematemesis Results: The use of NSAID and CS is not statistically significantly associated with UO and SUO,
but the use of ASA is statistically significantly associated with RB (P=0,024), M (P=0,003) and SUO
Urinary tract infection Non-specific hemorrhage of GI tract
(P=0,000).

The American Journal of GASTROENTEROLOGY VOLUME 112 | SUPPLEMENT 1 | OCTOBER 2017 www.nature.com/ajg
 Abstracts S301

Methods: This study included 176 patients with colonic diverticular hemorrhage from February 2012 to
[559_B] Independent predictors of readmission February 2017 in Saga Medical Center Koseikan, and 52 patients were treated with EBL and 34 patients
were treated with EC. All the patients in each group were followed up after hemostasis for checking
Factor Univariate Odds P-value Multivariate Odds P-value re-bleeding for one year.
ratio (95% confi- ratio (95% confi- Results: Re-bleeding occurred in 4 out of 52 patients (7.7%) with EBL and in 13 out of 34 (38.2%) patients
dence interval) dence interval) with EC. Each patient was checked the bleeding point and treated by endoscopic hemostasis. Regarding
re-bleeding from the same diverticula, only 3.8% (2 out of 52 patients) was suffered after treatment with
Female sex 1.05 (1.01–1.08) <0.01 1.06 (1.02–1.09) <0.01 EBL hemostasis, whereas 17.6% (6 out of 34 patients) was suffered after EC hemostasis These differences
were statistically significant (P=0.03).
Age 1.004 (1.003–1.005) <0.01 0.99 (0.99–1.00) <0.01 Conclusion: The present pilot examination suggested that EBL might be superior to EC in prevention
from the same colon diverticula re-bleeding from the same diverticula, which warrant a clinical trial with
Median Income in the patient’s zipcode multicenter study and/or randomized comparison in Japan.
$1 - $38,999 Reference Reference

  $39,000 - $47,999 0.91 (0.88–0.95) <0.01 0.95 (0.91–0.99) 0.02

  $48,000 - 62,999 0.84 (0.80–0.88) <0.01 0.88 (0.834–0.92) <0.01 564

  $63,000 or more 0.86 (0.82–0.90) <0.01 0.92 (0.88–0.97) <0.01 Adrenal Insufficiency Is Associated With Increased Morbidity and Use of Resources in Patients
With Upper Gastrointestinal Non-variceal Bleeding: A Nationwide Outcome Analysis
Insurance
Daniel Castaneda, MD1, Praneet Wander, MD2, Elijah Verheyen, MD1, Belen Machado, MD3, Violeta
 Medicare Reference Reference
Popov, MD, PhD, FACG4. 1Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, NY; 2Mount
 Medicaid 1.23 (1.17–1.30) <0.01 1.21 (1.13–1.29) <0.01 Sinai St. Luke's and Mount Sinai Roosevelt, New York, NY; 3Fundacion Universitaria San Martin, Bogota,
Distrito Capital de Bogota, Colombia; 4New York University School of Medicine, New York, NY
 Private 0.57 (0.54–0.61) <0.01 0.61 (0.57–0.65) <0.01

 Uninsured 0.59 (0.55–0.64) <0.01 0.65 (0.60–0.71) <0.01 Introduction: Adrenal insufficiency (AI) is a clinical entity frequently unrecognized due to its nonspe-
cific symptoms. It may lead to increased risk of systemic illness in conditions that precipitate shock, such
  Charlson comorbidity score 1.18 (1.17–1.19) <0.01 1.17 (1.16–1.18) <0.01 as hypovolemia. The incidence of AI and its effects in patients with upper gastrointestinal non-variceal
bleeding (UGINVB) is unknown. We aimed to determine the impact on the clinical outcomes of patients
Hospital NVUGIH volume quintile presenting with UGINVB in AI vs non-AI population.
 1 Reference Reference
Methods: A retrospective cohort study was done using the United States 2013 National Inpatient Sample,
the largest publicly available inpatient database in the United States. All patients with ICD-9 CM codes for
 2 1.04 (0.99–1.10) 0.12 1.03 (0.97–1.10) 0.26 a primary diagnosis of UGINVB were included. No exclusion criteria were used. The primary outcome
was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU)
 3 1.08 (1.02–1.14) 0.01 1.04 (0.98–1.11) 0.18 admission, shock, multi-organ dysfunction (MOD) and malnutrition; resource utilization measured by
abdominal ultrasound (US), abdominal CT scan (ACT), length of hospital stay (LOS), total parenteral
 4 1.08 (1.02–1.15) 0.01 1.03 (0.96–1.10) 0.41 nutrition (TPN) use, total hospitalization charges (TOC), esophagogastroduodenoscopy (EGD) and
colonoscopy. Patients were classified as AI or non-AI diagnosis based on ICD-9 CM codes. Odds ratios
 5 1.17 (1.10–1.24) <0.01 1.08 (1.00–1.16) 0.04
and means were calculated using multivariate regression analysis, after being adjusted for age, sex, race,
  Teaching hospital 1.11 (1.07–1.15) <0.01 1.04 (0.98–1.11) 0.03 Charlson Comorbidity Index, median income in the patient’s zip code, hospital region, rural location,
size and teaching status.
  Upper Endoscopy 0.74 (0.71–0.77) <0.01 0.75 (0.72–0.78) <0.01 Results: A total of 138,700 patients with UGINVB were included. Mean age was 64.3 years and 44.9%
were female. 470 (0.34%) had AI diagnosis. In-hospital mortality rate was 1.74% overall, 4.2% in
  Endoscopic therapy 0.94 (0.91–0.97) <0.01 0.96 (0.93–1.00) 0.05 AI patients and 1.7% in non-AI patients. Adjusted odds ratios, means and P values are shown in
Table 1. On multivariate analysis, patients with AI had increased mortality (OR 2.64, 95% CI 0.92 – 7.58;
 Radiology –guided embolization 1.09 (0.95–1.27) 0.21 1.07 (0.92–1.25) 0.39
P=0.07) compared to the non-AI population. Regarding morbidity, ICU admission, shock, malnutri-
of a vessel
tion and MOD were more common in AI patients. Resource utilization, total charges, LOS, and TPN
Hospital bedsize use were higher in the AI group; the use of ACT/US and need for EGD/colonoscopy were the same in
both groups.
 Small Reference Reference Conclusion: Adrenal insufficiency is associated with increased morbidity in patients admitted with
UGINVB. These patients present an increase in resource hospitalization, particularly hospitalization
 Medium 1.06 (0.99–1.13) 0.06 1.04 (0.98–1.11) 0.20 charges, length of stay and TPN use. Special attention needs to be taken in these population due to worse
overall outcomes.
 Large 1.11 (1.05–1.17) <0.01 1.04 (0.97–1.10) 0.27

  Intensive care unit admission 1.11 (1.00–1.22) 0.04 0.97 (0.87–1.09) 0.60

  Hypovolemic shock 1.04 (0.97–1.12) 0.23 1.005 (0.93–1.09) 0.89 565

 Discharge to a rehabilitation 1.25 (0.97–1.62) 0.08 1.10 (0.84–1.43) 0.48
facility
In the control group of patients, GBS was superior to the RS and FRS in predicting UO, but FRS was
superior to the other scores in predicting M and SUO. In the study group of patients who have used
ASA or ASA+APD, GBS was superior to the FRS in predicting RB (AUC:GBS-0,70/RS-0,60/FRS-0,65).
Among patients who used ASA, there was no difference between FRS and GBS in predicting SUO
(AUC:GBS-0,68/RS-0,61/FRS-0,68). Among patients who used APD, GBS was superior to the RS and
FRS in predicting SUO.
Conclusion: The use of ASA, OAC and/or APD is statistically significantly associated with SUO. Among
patients who use ASA, OAC and/or APD, FRS is significantly less reliable in predicting SUO, compared
to the control group of patients. The use of these drugs does not affect significantly the usability of GBS
in the predicting UO.
563
Endoscopic Band Ligation for Colonic Diverticular Hemorrhage Reduced Rebleeding From the
Same Diverticula: Retrospective Pilot Chart Review
Naoyuki Tominaga, PhD1, Yasuhisa Sakata, MD, PhD2, Sanae Kawamura, MD3, Takuya Matsunaga,
MD4, Eri Takeshita, MD5, Koichi Miyahara, PhD6, Tomohito Morisaki, PhD7, Nanae Tsuruoka, MD,
PhD2, Yukika Tsukamoto, PhD, MD8, Ryo Shimoda, MD, PhD2, Ryuichi Iwakiri, AP2, Shinichi Ogata,
PhD1, Kazuma Fujimoto, MD, PhD2. 1Saga Medical Centre Koseikan, Saga, Japan; 2Saga Medical School,
Saga, Japan; 3Saga-Ken Medical Center Koseikan, Saga, Japan; 4Saiseikai Karatsu Hospital, Karatsu,
Saga, Japan; 5Yuaikai Oda Hospital, Kashima, Saga, Japan; 6Karatsu Red Cross Hospital, Karatsu, Saga,
Japan; 7Ureshino Medical Center, Ureshino, Saga, Japan; 8Arao Municipal Hospital, Arao, Kumamoto,
Japan
Prognostic Significance of Cardiac Troponin in Acute Gastrointestinal Bleeding
Umair Iqbal, MD1, Ayesha Jameel, MD1, Hafsa Anwar, MBBS2, Osama Siddique, MD3, Ahmad Chaudhary,
MD1. 1Bassett Medical Center, Cooperstown, NY; 2Dow University of Health Sciences, Cooperstown, NY;
3
Warren Alpert Medical School of Brown University, Providence, RI
Introduction: Acute gastrointestinal bleeding (AGIB) is responsible for over 300,000 hospitalizations
annually. Cardiovascular-related deaths accounts for 30% of the patients surviving the initial episode of
AGIB. The purpose of this study is to identify the impact of elevated troponin on short-term mortality
and length of stay (LOS) of these patients.
Methods: From July 2013 to July 2016, 290 patients admitted with a diagnosis of AGIB and who had
cardiac troponin I measured within 24 hours of presentation were retrospectively reviewed. Clinical vari-
ables including 30-day mortality, 30-day readmission and LOS were then compared between the groups
of troponin elevation and no troponin elevation.
Results: The overall 30-day mortality among patients with AGIB was 6.5% (19/290). Cardiac troponin
was elevated in 10% of patients (29/290). Among patients with normal troponin, 5% (13/261) died within
30 days. In patients with troponin elevation, 21% died in the same period (6/29), P=0.001. The LOS was
also higher in patients with troponin elevation (4.88 vs 5.45, P=0.02). There was no difference in 30-day
readmission among the two groups. Past history of Coronary artery disease, Congestive Heart Failure,
Hypertension, aspirin use and elevated creatinine were more common in patients with troponin eleva-
tion troponin elevation. On multivariate analysis, troponin elevation on presentation is associated with
increased mortality (Odds 5.50, [CI: 1.73-17.47], P=0.004).
Conclusion: Cardiac troponin I is the sensitive marker for myocardial ischemia, especially in assess-
ing acute coronary syndromes. Elevated troponin can occur in non-cardiac conditions including AGIB
and represent cardiac injury. Diminished oxygen delivery secondary to anemia and hypotension and
increased oxygen demand due to tachycardia are the main reasons for myocardial ischemia and subse-
quent troponin elevation in GI bleeding. The severity of AGIB is usually assessed by Rockall and Blatch-
ford score, with higher scores associated with higher mortality. Given association of troponin with higher
mortality in AGIB, it can be used as a biomarker to risk-stratify the patients on admission, especially in
those with pre-existing cardiovascular disease as elevated levels are associated with poor outcomes and
higher utilization of resources. This study suggest 30-day mortality and length of stay are higher among
patients with troponin elevation.

Introduction: The endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with
colonic diverticular bleeding as several reports suggest that EBL might be superior to endoscopic clip-
ping (EC) for hemostasis. One of the reasons for the better outcome with EBL compared to EC could be
a superior effect on late bleeding, and this effect has not been clearly demonstrated. This retrospective
study compared the re-bleeding rate in of the bleeding colon diverticulum treated with EBL compared
to that treated with EC.

© 2017 by the American College of Gastroenterology  The American Journal of GASTROENTEROLOGY