S1390 Association of Anxiety Disorders and Mortality Among Critically Ill Upper Gastrointestinal Tract Bleeding Patients: A Population-Based Cohort Study

Introduction: Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening condition, with an annual incidence of 80 to 150 cases per 100,000 population and mortality rate of 2% to 10%. Anxiety disorders are prevalent, affecting up to 34% of individuals over their lifetime. Despite their high prevalence, the impact of anxiety disorders on critically ill patients hospitalized with UGIB remains unclear. Our study aims to explore the association between anxiety disorders and clinical outcomes in critically ill patients admitted with UGIB. Methods: We conducted a population-based cohort study using deidentified, publicly available data on adults admitted to Texas acute care ICU units from 2016–2023 with a principal diagnosis of UGIB, identified using International Classification of Diseases, Tenth Revisions, Clinical Modification codes selected from Clinical Classification Software Refined (CCSR) category DIG021: Gastrointestinal Hemorrhage. The primary exposure was anxiety disorders identified using CCSR category MBD005: Anxiety and fear-related disorders. Primary outcomes included in-hospital mortality, short-term mortality, and length of stay. Overlap propensity score weighting was applied with results expressed as adjusted risk ratio and 95% confidence interval. Results: Among 79,900 hospitalizations for UGIB, 11.7% had anxiety disorders. These patients were younger (48.1% vs 58.7% aged ≥65 years, P < 0.0001) and with lower Deyo comorbidity index (P < 0.0001). Anxiety disorders was associated with lower in-hospital (1.8% vs 3.1%) and short-term mortality (4.2% vs 6.0%). Adjusted analysis showed no association with in-hospital mortality (aRR 0.90, 95% CI 0.81–1.00), but remained associated with short-term mortality (aRR 0.80, 95% CI 0.68–0.93). Although mean length of stay was similar, anxiety disorders was associated with slightly longer adjusted length of stay (aRR 1.03, 95% CI 1.05–1.07). Conclusion: Critically ill UGIB patients with anxiety disorders had lower inpatient and short-term mortality compared to published literature. This may be attributed to the higher prevalence of anxiety disorders among younger patients and their lower burden of chronic conditions. Rebleeding rates did not differ significantly between groups. Differences in comorbidities, organ dysfunction, and treatment utilization suggest that UGIB patients with anxiety disorders may represent a distinct clinical phenotype with a potentially better prognosis compared to those without anxiety disorders.