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Temporal trends of cirrhosis associated conditions
Tomoki Sempokuya1, Guangxiang Zhang2, Kazuma Nakagawa2
1Department of Internal Medicine, the Queen's Medical Center, Honolulu, HI 968132, United States. tsempoku@hawaii.edu.
Insights
Hospitalizations for cirrhosis complications like hepatic encephalopathy/coma (HC) and spontaneous bacterial peritonitis (SBP) increased significantly from 2005-2014. Despite rising costs, inpatient mortality rates for most cirrhosis conditions decreased.
Area of Science:
- Hepatology
- Gastroenterology
- Public Health
Background:
- Chronic liver disease and cirrhosis are a leading cause of death in the US.
- Decompensated cirrhosis, particularly with hepatic encephalopathy/coma (HC), leads to high readmission rates and healthcare costs.
Purpose of the Study:
- To evaluate national inpatient trends in discharges, mortality, and financial impacts for four common cirrhosis complications.
- Analyze temporal changes in hospitalizations for HC, TIPS, EV, and SBP.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project National Inpatient Sample database (2005-2014).
- Examined trends in discharges, mortalities, and inpatient costs for HC, TIPS, EV, and SBP.
- Assessed ten-year trends using linear and multiple regression analyses.
Main Results:
- Discharges increased for HC (70%), SBP (819%), and EV (9%). Viral hepatitis-related HC showed a faster increase (357%).
- In-hospital mortality rates decreased for HC (29%), SBP (26%), and TIPS (32%), but not for EV.
- Aggregate hospitalization costs significantly increased for EV (20%), HC (86%), and SBP (980%) after inflation adjustment.
Conclusions:
- Hospitalizations and associated costs for several cirrhosis complications have risen.
- Inpatient mortality rates for most evaluated cirrhosis-associated conditions have declined.
- Findings highlight the growing burden of cirrhosis complications on healthcare systems.
Background:
Chronic liver disease and cirrhosis is the 12th leading cause of death in the United States. Patients with decompensated-cirrhosis, especially with hepatic encephalopathy/coma (HC), have a higher rate of early readmission and contribute to higher healthcare cost.
Aim:
To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis.
Methods:
The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant.
Results:
From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357% (P < 0.0001) in comparison to HC not related to viral hepatitis by 33 % (P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3% (P = 0.95).
Conclusion:
The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased.
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