MON-180 Risk for Hypercoagulability Among Patients with Cushing Syndrome. From the National Inpatient Sample

Background: Patients with Cushing syndrome are at higher risk for hypercoagulability due to elevated levels of pro-coagulants and impaired fibrinolysis. Objective: We aimed to examine the association of Cushing syndrome and hypercoagulability using a large national database. Methods: The National Inpatient Sample (NIS) was queried for all patients diagnosed with Cushing syndrome during the year 2011-2015. Patients with Cushing syndrome were identified using the international classification of diseases (ICD-9) code “2550”. The control group was randomly selected from the same database in a 4:1 ratio matched by age and gender. Hypercoagulable state was defined by presence of either ICD-9 codes “28981 or 28982” for primary and secondary hypercoagulable state as well as personal history of venous thrombosis or pulmonary embolism identifed with ICD-9 codes “V1251 and V1255” respectively. Patients who were diagnosed with autoimmune diseases, solid tumors, metastatic cancer, as well as those who were bed-bound were excluded. Multivariable logistic regression with adjustment for patient’s demographics, socioeconomic factors, comorbidities and hospital factors was used to obtain Cushing syndrome related risk for hypercoagulability. Subgroup analysis was performed based on gender, race and age groups; young adults (aged 18-35 years), middle-aged (> 35-<55 years) and older adults (aged > 55 years). Results: A total of 43,157 patients diagnosed with Cushing syndrome were identified. The mean age was 53.9 years (standard error of the mean 0.1). Majority of patients were females (75.2%) and of Caucasian race (74.6%). The prevalence of hypercoagulability was markedly higher among patients with Cushing syndrome 10 % vs 4%, p <0.001. On multivariable analysis, presence of Cushing syndrome correlated with significanlty higher risk for hypercoagulability with adjusted odd ratio (a OR) 2.20 [95%CI: 1.98-2.44] p <0.001. The risk for hypercoagulability was highest among young patients (age ≤ 35) with a OR 6.02 [95%CI: 4.06-8.94] p<0.001 and among Hispanics with a OR 3.66 [95%CI: 2.38-5.64] p<0.001. No significant gender difference on risk for hypercoagulability. Conclusion: Patients with Cushing syndrome are at higher risk for hypercoagulability. This risk is markedly higher among young patients and among Hispanics. Particular attention for early detection and prevention of venous thromboembolism in patients with Cushing Syndrome is advisable.