1064 Influenza in Cirrhosis Patients: A Multi-Year Nationwide Analysis

Abstract

INTRODUCTION: Influenza is an acute and usually self-limited febrile respiratory illness. However, it is associated with increased morbidity and mortality in certain high-risk populations including patients with liver disease. Interestingly, the data on this group has been always limited. METHODS: The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (2010-2014) was used for this analysis. Using with International Classification of Diseases, Ninth Revision, Clinical Modification codes (ICD-9-CM), the patients with a primary discharge diagnosis of influenza were identified. Similarly, the patients with a secondary discharge diagnosis of cirrhosis were identified. Our primary outcome is to assess the effect of cirrhosis on inpatient mortality among patients who were admitted with influenza. Our secondary outcomes include the length of stay and hospitalization charges. Categorical variables were compared using the chi-square test, and continuous variables were compared using Student t-test. All P values were 2 sided, with .05 as the threshold for statistical significance. All analysis was performed with SPSS 25 (IBM, USA). RESULTS: There were 36,680 discharges with a primary diagnosis of influenza between 2010 and 2014; 444 of these discharges (1.2%) have a secondary diagnosis of cirrhosis. Patients with influenza with and without Cirrhosis had comparable mean age, sex, and race (Table 1). Cirrhosis among patients with Influenza was associated with a higher mortality rate of 5% compared to 1.8% in patients without cirrhosis (OR 2.85, 95% CI 1.85 to 4.41, P < 0.0001). There was a minor increase in mean length of stay in influenza patients with a history of cirrhosis compared to non-cirrhotics (5.26 days vs 4.48 days, P < 0.0001). The mean hospitalization cost was significantly higher in influenza patients with cirrhosis ($45059.66 vs $32421.75, P < 0.0001). After adjustment for patient characteristics on a multivariable analysis (Table 2), cirrhosis was independently associated with higher mortality among patients with influenza (OR 3.09, 95% CI 1.99 to 4.78, P < 0.0001). CONCLUSION: Among the patients who were admitted with influenza, cirrhosis was associated with nearly three times higher mortality compared to non-cirrhotics. The mean length of stay and mean hospitalization cost were also higher in patients with cirrhosis.