76 Hepatorenal Syndrome Carries the Highest Risk of In-Hospital Mortality Among Hospitalized Patients With Primary Biliary Cholangitis

Abstract

INTRODUCTION: Primary biliary cholangitis (PBC) is an autoimmune and progressive cholestatic liver disease with significant morbidity and mortality. Hospitals with safety-net burden (SNB) provide an essential role to serving low-income and historically vulnerable populations. We aim to evaluate factors, including hospital SNB, associated with in-hospital mortality among hospitalizations with PBC. METHODS: Using the 2012–2014 National Inpatient Sample, we evaluated US adults hospitalized with PBC (using ICD-9 codes). Hospital SNB was defined as the percentage of hospitalizations among PBC with Medicaid or uninsured payer status per hospital, and was categorized into two groups: no SNB vs. any SNB. Between-group comparisons used chi-squared testing. Survey-weighted, adjusted multivariate logistic regression analysis was used to evaluate factors associated with in-hospital mortality. RESULTS: Among 7,364 hospitalizations with PBC (mean age 64.0 + 14.3y, 16.1% men, 70.3% non-Hispanic White), 65.3% were in no SNB and 34.7% were in low-high SNB hospitals. Crude in-hospital mortality was 4.15%, with no significant differences by hospital SNB. On adjusted regression, among the cirrhosis-related complications analyzed, the presence of ascites (OR 1.85, 95% CI 1.36–2.52, P < 0.001), hepatic encephalopathy (OR 2.32, 95% CI 1.75–3.08, P < 0.001) and hepatorenal syndrome (OR 7.58, 95% CI 5.12–11.2, P < 0.001) resulted in higher odds of in-hospital mortality compared to those without the respective complication present. Additionally, hospitalizations at urban teaching hospitals also had a higher odds of in-hospital mortality compared to rural hospitals (OR: 2.04, 95% CI: 1.20–3.46, P = 0.01). CONCLUSION: Hospitalizations with PBC with concomitant cirrhosis-related complications had significantly higher odds of in-hospital mortality. Specifically, PBC hospitalizations with hepatorenal syndrome were 7.6 times more likely to die during hospitalization. Urban teaching hospitals also had higher in-hospital mortality compared to rural hospitals.