{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:06:18Z","timestamp":1784264778057,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although immune checkpoint inhibitors (ICIs) have transformed cancer treatment, they are associated with immune-related adverse events, including gastrointestinal (GI) toxicity. While GI bleeding is a common cause of hospitalization among cancer patients, the relationship between ICI exposure and the outcomes of GI bleeding at the national level remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study utilized data from the National Inpatient Sample (NIS) between 2018 and 2022. Adult cancer patients hospitalized with GI bleeding were identified and stratified by ICI exposure. The primary outcome was in-hospital mortality. Secondary outcomes included colectomy, intensive care unit (ICU) admission, and blood transfusion. Survey-weighted logistic regression models, adjusted for demographics, insurance, income, admission type, and year, were employed. Sensitivity analyses included adjustments for Elixhauser comorbidities, inverse probability of treatment weighting (IPTW), propensity score matching, exclusion of records with inpatient antineoplastic chemotherapy codes, exclusion of records from pandemic years, and alternative ICU-proxy thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 130,557 hospitalizations, 33,130 (25.4%) involved ICI exposure. ICI exposure was associated with significantly lower in-hospital mortality (adjusted odds ratio [aOR] 0.57, 95% confidence interval [CI] 0.54\u20130.60,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), colectomy (aOR 0.65, 95% CI 0.60\u20130.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and ICU admission (aOR 0.66, 95% CI 0.64\u20130.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Blood transfusion was modestly more frequent in the ICI group (aOR 1.04, 95% CI 1.00\u20131.08,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.034); this association was small in magnitude and was no longer significant when the pandemic years were excluded. The results were consistent across cancer subtypes, GI bleeding locations, and all sensitivity analyses (mortality aOR range 0.57\u20130.66).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICI exposure was associated with significantly lower in-hospital mortality, colectomy, and ICU admission among cancer patients hospitalized with GI bleeding. These findings likely reflect selection bias, as ICI-treated patients may represent a healthier subpopulation of cancer patients. Further studies incorporating detailed clinical data are needed to elucidate the mechanisms underlying these associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1869656","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:23:51Z","timestamp":1784262231000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune checkpoint inhibitor exposure and outcomes of gastrointestinal bleeding in cancer patients: a national analysis of 130,557 hospitalizations, 2018\u20132022"],"prefix":"10.3389","volume":"13","author":[{"given":"Wael","family":"Alkattan","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Barnawi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Chalabi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maamon","family":"Mallisho","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek Ziad","family":"Arabi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Alaswad","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abderrahman","family":"Ouban","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/COC.0000000000000239","article-title":"CTLA-4 and PD-1 pathways: similarities, differences, and implications of their inhibition","volume":"39","author":"Buchbinder","year":"2016","journal-title":"Am J Clin Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3044","DOI":"10.3390\/curroncol29050247","article-title":"Immune checkpoint inhibitors in cancer therapy","volume":"29","author":"Shiravand","year":"2022","journal-title":"Curr Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e192535","DOI":"10.1001\/jamanetworkopen.2019.2535","article-title":"Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs","volume":"2","author":"Haslam","year":"2019","journal-title":"JAMA Netw Open"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e200423","DOI":"10.1001\/jamanetworkopen.2020.0423","article-title":"Estimation of the percentage of US patients with Cancer who are eligible for immune checkpoint inhibitor drugs","volume":"3","author":"Haslam","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"730","DOI":"10.3389\/fphar.2017.00730","article-title":"Immune-related adverse events associated with anti-PD-1\/PD-L1 treatment for malignancies: a meta-analysis","volume":"8","author":"Wang","year":"2017","journal-title":"Front Pharmacol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1158\/2326-6066.cir-16-0237","article-title":"Comprehensive meta-analysis of key immune-related adverse events from CTLA-4 and PD-1\/PD-L1 inhibitors in cancer patients","volume":"5","author":"De Velasco","year":"2017","journal-title":"Cancer Immunol Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1038\/nrgastro.2018.14","article-title":"Gastrointestinal toxicity of immune checkpoint inhibitors: from mechanisms to management","volume":"15","author":"Samaan","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"102440","DOI":"10.1016\/j.ctrv.2022.102440","article-title":"Immune checkpoint inhibitor\u2013induced diarrhea and colitis: incidence and management. 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