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Published on: September 13, 2014
Hospitalizations for Acute on Chronic Liver Failure at Academic Compared to Non-academic Centers Have Higher
Ashwani K Singal1, Zunirah Ahmed2, Page Axley3
1Division of Gastroenterology and Hepatology, Department of Medicine, Transplant Hepatologist and Chief Clinical Research Affairs, Avera McKennan University Hospital Transplant Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA. ashwanisingal.com@gmail.com.
Insights
Acute on chronic liver failure (ACLF) admissions have high mortality, especially at academic centers. While in-hospital deaths decreased, academic centers still showed higher mortality rates for ACLF patients.
Area of Science:
- Hepatology
- Critical Care Medicine
- Health Services Research
Background:
- Acute on chronic liver failure (ACLF) in cirrhosis patients carries a significant short-term mortality risk.
- Limited data exists comparing outcomes for ACLF admissions between academic centers (AC) and non-academic centers (NAC).
Purpose of the Study:
- To compare the characteristics and outcomes of ACLF admissions to academic versus non-academic centers.
- To analyze trends in ACLF admissions and mortality over time.
- To identify disparities in care and resource utilization between AC and NAC for ACLF patients.
Main Methods:
- Utilized the National Inpatient Sample (2006-2014) database.
- Identified admissions for cirrhosis and ACLF using ICD-09 codes.
- Stratified admissions to AC or NAC and matched cohorts for detailed comparison.
Main Results:
- ACLF occurred in 5.9% of cirrhosis admissions, with a higher proportion at AC (6.7%) versus NAC (5%).
- ACLF admissions to AC increased from 49% to 59% between 2006-2008 and 2012-2014.
- Matched ACLF cohorts showed higher in-hospital mortality (46% vs. 42%) and longer length of stay at AC compared to NAC.
Conclusions:
- ACLF patients face high in-hospital mortality, which is notably higher in academic centers.
- Despite an overall decline in mortality, strategies are needed for early identification of care futility and optimal resource allocation in ACLF admissions.
- Further research should focus on improving outcomes and resource management for ACLF patients, particularly within academic medical settings.
Background And Aim:
Acute on chronic liver failure (ACLF) in patients with cirrhosis has high short-term mortality. Data comparing ACLF admissions to academic centers (AC) and non-academic centers (NAC) are scanty.
Methods:
National Inpatient Sample (2006-2014) was queried for admissions with cirrhosis and ACLF using the ICD-09 codes, and was stratified to AC or NAC.
Results:
Of 1,928,764 admissions with cirrhosis (2006-2014), 112,174 (5. 9%) had ACLF. 6.7% of 1,018,568 cirrhosis admissions to AC had ACLF versus 5% of 910,196 admissions to NAC, P < 0.0001. Proportion of ACLF admissions to AC increased from 49% during 2006-2008 to 59% during 2012-2014. In a cohort of 73,630 ACLF admissions (36,615 each to AC and NAC) matched for patient demographics, cirrhosis etiology, number of comorbidities, elective versus emergent admission, ACLF grade, and type of organ failure. In-hospital mortality declined by 7% over the study period, but remained higher in AC (46% vs. 42%, P < 0.001), with 11% increased odds for in-hospital mortality compared to admission to NAC. Further admissions to AC versus NAC had higher median (IQR) length of stay at 13 (6-25) versus 11 (5-20) days, with higher median (IQR) hospital charges: 138,239 (66,772-275,603) versus 116,209 (55,767-232,699) USD, P < 0.001 for both.
Conclusion:
Patients with ACLF have high in-hospital mortality. Further, this is higher among admissions to AC. Although the in-hospital mortality is improving, strategies are needed on early identification of patients with futility of care for early discussion on goals of care, and optimal utilization of hospital resources among admissions with ACLF.
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