Healthcare Utilization and Inpatient Burden of Hepatorenal Syndrome Associated With Acute and Subacute Hepatic Failure 897

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S499
• Main Authors: Chakinala, Raja Chandra, Haq, Khwaja F., Solanki, Shantanu, Chugh, Priyanka, Mehta, Dhruv, Ali Khan, Muhammad, Khan, Zubair, Siddiqui, Nauman, Bhurwal, Abhishek, Haq, Khwaja S., Burney, Anam S., Burney, Azam H., Wolf, David C.
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Age groups; Gastroenterology; Health services utilization; Mortality; Trends
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-00897

Introduction: Hepatorenal syndrome (HRS) is characterized by development of renal failure in patients with advanced chronic liver disease or, less commonly, with acute or subacute hepatic failure. Limited data exists on national inpatient hospitalization trends, demographic variation, cost of care and outcomes in patients with discharge diagnoses of HRS associated with acute and subacute hepatic failure. Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of acute and subacute hepatic failure (ICD-9 code 570) as primary or secondary diagnosis during the period from 2001-2011. Subjects with a discharge diagnosis of HRS (ICD-9 code 572.4) were then identified, trends were analyzed and statistical significance of variation was determined using CochranArmitage trend test. Results: From 2001 to 2011, the number of hospitalizations with a discharge diagnosis of acute and subacute hepatic failure increased from 6,867 to 8,609. The discharge diagnosis of HRS in association with acute and subacute hepatic failure more than doubled from 325 in 2001 to 716 in 2011 (p< 0.0001, figure 1A). Male gender and white race remained more affected with an increase in proportional trend (p= 0.01). Age group 35-49 showed a decrease in trend as age group 50-64 showed an increased in trend becoming dominant in 2011 with the greatest proportion of discharge diagnosis with HRS associated with acute and subacute hepatic failure (p< 0.0001, figure 1B). In-hospital mortality decreased from 56.47% to 39.74% (p< 0.0001, figure 1C), but the mean cost of care increased from $31,583 to $32,522 (adjusted for inflation, p= 0.002, figure 1D). Conclusion: The number of hospitalizations for HRS associated with acute and subacute hepatic failure is increasing. Encouragingly, there was a significant reduction in mortality over the study period. This was likely due to advances in management, along with early recognition of HRS and timely initiation of therapy. The cost of care increased significantly between 2001 and 2011.