Abstract
BackgroundHepatocellular Carcinoma (HCC) is a severe complication of cirrhosis and the incidence of HCC has been increasing in the United States (US). We aim to describe the trends, characteristics, and outcomes of hospitalizations due to HCC across the last decade.MethodsWe derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult hospitalizations due to HCC were identified using the International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). Comorbidities were also identified by ICD-9/10-CM codes and Elixhauser Comorbidity Software (Agency for Healthcare Research and Quality, Rockville, Maryland, US). Our primary outcomes were in-hospital mortality and discharge to the facility. We then utilized the Cochran-Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors.ResultsA total of 155,436 adult hospitalizations occurred due to HCC from 2008-2017. The number of hospitalizations with HCC decreased from 16,754 in 2008 to 14,715 in 2017. Additionally, trends of in-hospital mortality declined over the study period but discharge to facilities remained stable. Furthermore, in multivariable regression analysis, predictors of increased mortality in HCC patients were advanced age (OR 1.1; 95%CI 1.0-1.2; p< 0.0001), African American (OR 1.3; 95%CI 1.1-1.4;p< 0.001), Rural/ non-teaching hospitals (OR 2.7; 95%CI 2.4-3.3; p< 0.001), uninsured (OR 1.9; CI 1.6-2.2; p< 0.0001) and complications like septicemia and pneumonia as well as comorbidities such as hypertension, diabetes mellitus, and renal failure. We observed similar trends in discharge to facilities.ConclusionsIn this nationally representative study, we observed a decrease in hospitalizations of patients with HCC along with in-hospital mortality; however, discharge to facilities remained stable over the last decade. We also identified multiple predictors significantly associated with increased mortality, some of which are potentially modifiable and can be points of interest for future studies.
Highlights
Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer and one of the leading causes of cancer-related deaths [1]
Trends of inhospital mortality declined over the study period but discharge to facilities remained stable
In multivariable regression analysis, predictors of increased mortality in Hepatocellular Carcinoma (HCC) patients were advanced age, African American, Rural/ non-teaching hospitals, uninsured and complications like septicemia and pneumonia as well as comorbidities such as hypertension, diabetes mellitus, and renal failure
Summary
Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer and one of the leading causes of cancer-related deaths [1]. Comprehensive screening for HCC and effective treatment for HBV and HCV can potentially decrease HCC incidence and hospitalization rates. Previous population-based studies that utilized data from different databases in the US showed that between 2008 and 2015, the incidence of HCC either plateaued or remained stable [10,11,12]. The impact of this on HCC hospitalizations during the aforementioned and the years after is unknown. There is some fair evidence to suggest that screening leads to early detection of HCC, improved curative rates, and improved survival [14]. We aim to describe the trends, characteristics, and outcomes of hospitalizations due to HCC across the last decade
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