In-hospital Outcomes of Patients With Acute Decompensated Heart Failure And Cirrhosis An Analysis of The National Inpatient Sample

Abstract

Introduction Heart failure theoretically increases morbidity and mortality in patients admitted for cirrhosis. However, there is a paucity of data regarding the influence of sex, race, insurance, and cirrhosis related complications on mortality, length of stay, and total hospitalization charges. In this study we aim to identify risk factors in a national population cohort admitted in 2016. Methods All patients >18 years old with Cirrhosis and acute decompensated heart failure (ADHF) admitted in 2016 were identified from the Nationwide Inpatient Sample. Multivariate Regression analysis was used to estimate the odds ratio of in-hospital mortality, average length of stay and hospital charges, after adjusting for age, gender, race, Charlson and Elixhauser score, primary insurance payer, hospital type, hospital bed size, hospital region, hospital teaching status, mortality rate, length of stay, associated charges, and demographic characteristics. Statistical analysis was performed by using SAS Survey Procedures (SAS 9.4, SAS Institute Inc, Cary, NC, USA). Statistical significance was defined by the two-sided test with a p-value Results Overall sample included 363,050 patients. 355,455 patients were admitted with ADHF, of which 2% were complicated with cirrhosis (n=7,595) in 2016. Total Mortality rate was 3.4%, length of stay 6.6 days (6.5) and mean total hospital charge was $63,120.2.Patients with ADHF and cirrhosis compared to patients without ADHF have increased mortality, length of stay, and cirrhosis related complications. Independent predictors of mortality were hepatorenal syndrome (HRS), ascites, and hepatic encephalopathy (HE). Hispanic race and Medicare were negative predictors, associated with worse outcomes. Length of stay was increased if patients had Medicare, HRS, and ascites. Predictors of total hospital charge were Hispanic ethnicity, Asian/pacific islander race, HRS, ascites and HE. Conclusions ADHF in patients with cirrhosis leads to increased mortality and hospital utilization. We identified key drivers for these outcomes. Targeted interventions are needed for the subgroups identified in this study.