Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States.

Charat Thongprayoon,Tarun Bathini,Ploypin Lertjitbanjong,Fawad Qureshi,Tananchai Petnak,Wisit Kaewput,Boonphiphop Boonpheng,Saraschandra Vallabhajosyula,Pattharawin Pattharanitima,Wisit Cheungpasitporn,Oisin A O’Corragain

doi:10.3390/medicines8050021

Abstract

Background: This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Methods: Using the National Inpatient Sample, hospital admissions with a primary diagnosis of hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient palliative care service use. Logistic and linear regression was performed to assess the impact of inpatient palliative care service on in-hospital treatments and resource use. Results: Of 5571 hospital admissions for hepatorenal syndrome, palliative care services were used in 748 (13.4%) admissions. There was an increasing trend in the rate of palliative care service use, from 3.3% in 2003 to 21.1% in 2014 (p < 0.001). Older age, more recent year of hospitalization, acute liver failure, alcoholic cirrhosis, and hepatocellular carcinoma were predictive of increased palliative care service use, whereas race other than Caucasian, African American, and Hispanic and chronic kidney disease were predictive of decreased palliative care service use. Although hospital admission with palliative care service use had higher mortality, palliative care service was associated with lower use of invasive mechanical ventilation, blood product transfusion, paracentesis, renal replacement, vasopressor but higher DNR status. Palliative care services reduced mean length of hospital stay and hospitalization cost. Conclusion: Although there was a substantial increase in the use of palliative care service in hospitalizations for hepatorenal syndrome, inpatient palliative care service was still underutilized. The use of palliative care service was associated with reduced resource use.

Highlights

Hepatorenal syndrome is a severe complication of end-stage liver disease characterized by splanchnic vasodilation resulting in decreased renal blood flow [1]
Age ≥ 60 years, more recent year of hospital admissions, acute liver failure, alcoholic cirrhosis, and hepatocellular carcinoma were predictive of increased palliative care service use, whereas race other than Caucasian, African American, and Hispanic and chronic kidney disease were predictive of decreased palliative care service use (Table 2)
Our study demonstrated that several acute conditions did not predict palliative care consultation, high mortality of up to 50% associated with acute liver failure supports the important role of palliative care [16]

Summary

Introduction

Hepatorenal syndrome is a severe complication of end-stage liver disease characterized by splanchnic vasodilation resulting in decreased renal blood flow [1]. Since hepatorenal syndrome is typically associated with long standing and greater severity of end-stage liver disease, other complications commonly coexist, such as ascites, esophageal varices, or hepatic encephalopathy [6]. These patients usually suffer from physical and psychological symptoms [7]. This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Conclusion: there was a substantial increase in the use of palliative care service in hospitalizations for hepatorenal syndrome, inpatient palliative care service was still underutilized. The use of palliative care service was associated with reduced resource use

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