S2785 Inflammatory Bowel Disease Lowers Resource Use Without Raising Mortality in Hospitalized Primary Sclerosing Cholangitis Patients

Introduction: Primary sclerosing cholangitis (PSC) is characterized by progressive fibrosis and stricturing of the intra- and extra-hepatic bile ducts. It is frequently associated with inflammatory bowel disease (IBD), more commonly ulcerative colitis (UC) than Crohn’s disease (CD). Whether co-existing IBD alters inpatient outcomes remains unclear. Methods: Data from the National Inpatient Sample from the year 2018 to 2022 was queried to identify hospitalizations with a primary diagnosis of PSC using the respective International Classification of Diseases, Tenth Revision (ICD-10) codes. Further stratification was done into 3 groups: PSC-only, PSC + UC and PSC + CD. Outcomes of interest included in-hospital mortality, intensive care utilization, length of stay (LOS), total charges, cholangiocarcinoma and liver transplantation. Temporal trends across the 5 years were also examined. Analysis was performed using STATA version 18. Results: We identified 29,875 weighted PSC encounters over the 5 years: 50% with PSC only, 35% with PSC + UC and 15% with PSC + CD. Overall mortality in this cohort was low (2.8%) and did not differ among groups (P > 0.05). ICU level care was lower in the PSC + IBD group at 3%, vs 4.3% of the PSC-only cohort (P = 0.037). Cholangiocarcinoma was diagnosed in 6% of all PSC admissions. Six percent of the patients underwent liver transplant during index hospitalization with no difference by IBD status. Interestingly, the presence of IBD was associated with significantly less mean charges, US -$14,000 (P = 0.02) and decreased LOS, -0.4 days, though LOS was not statistically significant (P = 0.09). From 2018 to 2022, national LOS for PSC rose 11%. Mortality peaked at 3.2% in 2021 before dropping to 2.6% in 2022. Conclusion: In this analysis of nationwide hospitalizations, co-existing IBD did not increase PSC inpatient mortality and was associated with less ICU-level utilization and reduced charges. This could reflect earlier referral and closer surveillance in patients with IBD compared to those without. Despite low inpatient mortality, the high prevalence of cholangiocarcinoma and transplant needs remain high in this cohort and did not differ by IBD status.