Abstract

BackgroundAlcoholic hepatitis (AH) is a unique syndrome characterized by high short-term mortality. The impact of the academic status of a hospital (urban and teaching) on outcomes in AH is unknown.MethodsNational Inpatient Sample dataset (2006–2014) on AH admissions stratified to academic center (AC) or non-academic center (NAC) and analyzed for in-hospital mortality (IHM), hospital resource use, length of stay in days (d), and total charges (TC) in United States dollars (USD). Admission year was stratified to 2006–2008 (TMI), 2009–2011 (TM2), and 2012–2014 (TM3).ResultsOf 62,136 AH admissions, the proportion at AC increased from 46% in TM1 to 57% in TM3, Armitage trend, p < 0.001. On logistic regression, TM3, younger age, black race, Medicaid and private insurance, and development of acute on chronic liver failure (ACLF) were associated with admission to an AC. Of 53,264 admissions propensity score matched for demographics, pay status, and disease severity, admissions to AC vs. NAC (26,622 each) were more likely to have liver disease complications (esophageal varices, ascites, and hepatic encephalopathy) and hospital-acquired infections (HAI), especially Clostridioides difficile and ventilator-associated pneumonia. Admissions to AC were more likely transfers from outside hospital (1.6% vs. 1.3%) and seen by palliative care (4.8% vs. 3.3%), p < 0.001. Use of endoscopy, dialysis, and mechanical ventilation were similar. With similar IHM comparing AC vs. NAC (7.7% vs. 7.8%, p = 0.93), average LOS and number of procedures were higher at AC (7.7 vs. 7.1 d and 2.3 vs. 1.9, respectively, p < 0.001) without difference on total charges ($52,821 vs. $52,067 USD, p = 0.28). On multivariable logistic regression model after controlling for demographics, ACLF grade, and calendar year, IHM was similar irrespective of academic status of the hospital, HR (95% CI): 1.01 (0.93–1.08, p = 0.70). IHM decreased over time, with ACLF as strongest predictor. A total of 63 and 22% were discharged to home and skilled nursing facility, respectively, without differences on academic status of the hospital.ConclusionAdmissions with AH to AC compared to NAC have higher frequency of liver disease complications and HAI, with longer duration of hospitalization. Prospective studies are needed to reduce HAI among hospitalized patients with AH.

Highlights

  • Alcohol contributed to 48% of cirrhosis-related deaths in the United States in 2017, and alcohol-associated liver disease (ALD) accounts for 27% of these (GBD 2017 Cirrhosis Collaborators, 2020)

  • Baseline Characteristics Admissions With alcoholic hepatitis (AH): AC vs. NAC Admissions to AC compared to NAC differed on demographics

  • Admissions to AC were associated with more severe disease with ACLF (12% vs. 9%, p < 0.001) and various organ failures (Table 1)

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Summary

Introduction

Alcohol contributed to 48% of cirrhosis-related deaths in the United States in 2017, and alcohol-associated liver disease (ALD) accounts for 27% of these (GBD 2017 Cirrhosis Collaborators, 2020). AH most often occurs in individuals aged 40–60 years, with the majority of these individuals contributing to the most productive contingent of the workforce (Thompson et al, 2018). Taken together, these trends in alcohol consumption contribute toward burden on social, economic, and health care systems (Jinjuvadia and Liangpunsakul, 2015). The impact of the academic status of a hospital (urban and teaching) on outcomes in AH is unknown

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