954 Evaluation of Reasons for Admission in Patients With Decompensated Cirrhosis and Their Burden on Health Care Costs and Mortality Over the Years: Nationwide Analysis

Abstract

INTRODUCTION: Cirrhosis is considered the late stage irreversible sequela of progressive fibrosis and distortion of hepatic architecture. Patients with decompensated cirrhosis have significant morbidity and mortality and may present with signs of upper GI bleeding, ascites, confusion, and kidney injury. The aim of our study was to evaluate and report the trends for the most common causes of decompensation in patients with cirrhosis. METHODS: A retrospective cohort analysis was performed using the Nationwide Inpatient Sample (NIS) from 2007–2014. All patients with a diagnosis of cirrhosis, elective admission, and age greater than 18 years were included in our analysis. We evaluated those who had primary admission diagnosis for ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal variceal bleeding, and hepatorenal syndrome (HRS). We evaluated the trends of mortality, the length of stay, and cost of hospitalization. RESULTS: Ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal variceal bleeding, and HRS accounted for 44,614 admissions from 2007–2014 as a primary diagnosis. Mortality for HRS decreased from 36.59% to 24.05% (P < 0.001) from 2007 to 2014, representing average overall mortality of 30.32%. Furthermore, average length of stay (LOS) for spontaneous bacterial peritonitis went from 7.22 days to 6.42 days (P < 0.05). Average LOS went from 9.07 days to 7.88 days (P < 0.05) for hepatic encephalopathy. Average total charges of hospitalization went from $51,665 to $71,779 (P < 0.001) from 2007 to 2014 for hepatic encephalopathy. Average total charges of hospitalization went from $19,692 to $32,336 (P < 0.001) from 2007 to 2014 for ascites. Mortality for bleeding from esophageal varices increased from 5.21% to 6.11% (P < 0.001) from 2007 to 2014, representing average overall mortality of 5.59%. Average total charges of hospitalization went from $34,107 to $51,424 (P < 0.001) from 2007 to 2014 for hepatic encephalopathy. CONCLUSION: Admission for HRS represents approximately 30% overall mortality in patients with decompensated cirrhosis in our study. On the contrary, while the total mean charge for hospitalization increases, spontaneous bacterial peritonitis and hepatic encephalopathy has had significant decrease in LOS from 2007–2014. Clinicians should be vigilant for patients admitted for HRS as it represents high mortality. Further prospective studies are warranted to evaluate the causes for high mortality in decompensated cirrhosis.