Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study

Marjan Mujib; Neel Khanna; Nabila K. Mazumder; Wilbert S. Aronow; Dhaval Kolte; Sahil Khera; Chandrasekar Palaniswamy; Diwakar Jain; Gregg M. Lanier; Sachin Sule; Ali Ahmed; Wayne C. Levy; Sumanth D. Prabhu; Howard A. Cooper; Julio A. Panza; Alan L. Gass; Gregg C. Fonarow

doi:10.1002/clc.22391

Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study

Marjan Mujib, Neel Khanna, Nabila K. Mazumder, Wilbert S. Aronow, Dhaval Kolte, Sahil Khera, Chandrasekar Palaniswamy, Diwakar Jain, Gregg M. Lanier, Sachin Sule, Ali Ahmed, Wayne C. Levy, Sumanth D. Prabhu, Howard A. Cooper, Julio A. Panza, Alan L. Gass, Gregg C. Fonarow

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Abstract

Background The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. Hypothesis Pre-HT coagulopathy is associated with increased in-hospital mortality. Methods Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. Results The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). Conclusions In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.

Original language	English
Pages (from-to)	300-308
Number of pages	9
Journal	Clinical Cardiology
Volume	38
Issue number	5
DOIs	https://doi.org/10.1002/clc.22391
State	Published - May 1 2015

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Mujib, M., Khanna, N., Mazumder, N. K., Aronow, W. S., Kolte, D., Khera, S., Palaniswamy, C., Jain, D., Lanier, G. M., Sule, S., Ahmed, A., Levy, W. C., Prabhu, S. D., Cooper, H. A., Panza, J. A., Gass, A. L., & Fonarow, G. C. (2015). Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study. Clinical Cardiology, 38(5), 300-308. https://doi.org/10.1002/clc.22391

@article{c6cc7f47997c4c19be33e52159aa4e58,

title = "Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study",

abstract = "Background The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. Hypothesis Pre-HT coagulopathy is associated with increased in-hospital mortality. Methods Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. Results The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). Conclusions In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.",

author = "Marjan Mujib and Neel Khanna and Mazumder, {Nabila K.} and Aronow, {Wilbert S.} and Dhaval Kolte and Sahil Khera and Chandrasekar Palaniswamy and Diwakar Jain and Lanier, {Gregg M.} and Sachin Sule and Ali Ahmed and Levy, {Wayne C.} and Prabhu, {Sumanth D.} and Cooper, {Howard A.} and Panza, {Julio A.} and Gass, {Alan L.} and Fonarow, {Gregg C.}",

note = "Publisher Copyright: {\textcopyright} 2015 Wiley Periodicals, Inc.",

year = "2015",

month = may,

day = "1",

doi = "10.1002/clc.22391",

language = "English",

volume = "38",

pages = "300--308",

journal = "Clinical Cardiology",

issn = "0160-9289",

number = "5",

}

Mujib, M, Khanna, N, Mazumder, NK, Aronow, WS, Kolte, D, Khera, S, Palaniswamy, C, Jain, D, Lanier, GM, Sule, S, Ahmed, A, Levy, WC, Prabhu, SD, Cooper, HA, Panza, JA, Gass, AL & Fonarow, GC 2015, 'Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study', Clinical Cardiology, vol. 38, no. 5, pp. 300-308. https://doi.org/10.1002/clc.22391

TY - JOUR

T1 - Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients

T2 - A propensity-matched nationwide inpatient sample study

AU - Mujib, Marjan

AU - Khanna, Neel

AU - Mazumder, Nabila K.

AU - Aronow, Wilbert S.

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Palaniswamy, Chandrasekar

AU - Jain, Diwakar

AU - Lanier, Gregg M.

AU - Sule, Sachin

AU - Ahmed, Ali

AU - Levy, Wayne C.

AU - Prabhu, Sumanth D.

AU - Cooper, Howard A.

AU - Panza, Julio A.

AU - Gass, Alan L.

AU - Fonarow, Gregg C.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. Hypothesis Pre-HT coagulopathy is associated with increased in-hospital mortality. Methods Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. Results The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). Conclusions In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.

AB - Background The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. Hypothesis Pre-HT coagulopathy is associated with increased in-hospital mortality. Methods Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. Results The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). Conclusions In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.

UR - http://www.scopus.com/inward/record.url?scp=84929706911&partnerID=8YFLogxK

U2 - 10.1002/clc.22391

DO - 10.1002/clc.22391

M3 - Article

C2 - 25684174

AN - SCOPUS:84929706911

SN - 0160-9289

VL - 38

SP - 300

EP - 308

JO - Clinical Cardiology

JF - Clinical Cardiology

IS - 5

ER -

Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: A propensity-matched nationwide inpatient sample study

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