1091 Time-Trend Analysis of Correlation of Liver Cirrhosis and Its Complications, Using NIS Database

Abstract

INTRODUCTION: Liver cirrhosis has one of the highest associations with an increased mortality and morbidity, out of all liver diseases. Indirect and direct cost related to cirrhosis exceeded 10 billion dollars in 2010, and is expected to have risen since then. It has many complications such as esophageal varices, spontaneous bacterial peritonitis (SBP), portal hypertension and hepatorenal syndrome (HRS). We wanted to assess hospital admissions, stays and expenses of patient care from cirrhosis. METHODS: We reviewed the NIS Database for all hospitalizations with principal discharge diagnosis for cirrhosis, esophageal varices, SBP, portal hypertension or HRS between years 1993–2014. RESULTS: In 2014 total number of hospital admissions secondary to cirrhosis were 77,880. This was a persistent increase from 57,787 admissions in 1993. Age-sex standardized admission rates (per 100,000 patients) increased from 24.0 in 1993 to 32.3 in 2014. We saw decrease in hospital stay duration from 8.7 to 9.8 days. The total hospital charges for these admissions increased from $11,020 in 1993 to $59,130 in 2014. Average mortality per year decreased from 14.98% to 5.62%. On the other hand, opposite trends were observed in most of the complications of cirrhosis. We saw a steady decline in admission rate (per 100,000 patients) from esophageal varices, from 2.0 in 1993 to 1.4 in 2014. Mortality for the condition decreased from 8.13% to 6.04% over the course of the study period. Similar trends were observed in patients with HRS, with admission rate increasing from 0.5 to 1.1, in 1993 and 2014 respectively. In hospital death decreased from 70.9% in 1993 to 24% in 2014. Admission rate for portal hypertension from 1994 to 2014 increased from 1.5 to 1.8. Mortality from the disease continues to decrease from 6.1% in 1993 to 3.0% in 2013.Trend for SBP admissions over the past decade is concerning with numbers increasing from 0.3 in 2005, to 2.4 in 2014. Reassuringly, mortality for SBP is decreasing consistently from 8.34% in 2005 to 6.16% in 2014. CONCLUSION: The number of inpatient admissions for cirrhosis has increased from 1993 to 2014. During the same time period, length of stay and inpatient mortality improved but cost per admission increased almost five folds. These changes are likely representative of early recognition of complication and more effective treatment options. Use of diagnostic and therapeutic intervention should be judicious and further research on cost effectiveness of is needed.