S1034 The Effect of Cholangiocarcinoma on the Hepatic Outcomes of Hospitalized Patients With Liver Cirrhosis: A Nationwide Analysis

Abstract

INTRODUCTION: Patients with cirrhosis can develop cholangiocarcinoma (CCA) due to shared comorbidities including primary sclerosing cholangitis and metabolic risk factors. Since cirrhotic patients with CCA are at particular risk of hepatic decompensation with CCA involvement of the biliary/portal structures, it is important to evaluate the effect of CCA on the hepatic outcomes of these patients. METHODS: Patients with CCA were selected from the 2011 to 2017 National Inpatient Sample and were stratified by the presence of cirrhosis. The control patients were matched by age, gender, and race using a 1:4 propensity score matching algorithm. The two cohorts were compared using the following study endpoints: mortality, length of stay (LOS), hospitalization costs, and hepatic events. RESULTS: Of the 790014 patients with cirrhosis identified from the database 1470 (0.19%) patients were identified as having cholangiocarcinoma and 5880 were identified as matched controls. The two cohorts were both on average 63.4 years of age and both had a gender ratio of 68.8/31.2% male/female. The mortality rate was higher in the CCA cohort (9.32 vs 6.26% P < 0.01, OR 1.54 95%CI 1.25–1.89), as were the LOS (7.15 vs 6.19d P < 0.01) and hospitalization costs ($73,913 vs $63,149 P < 0.01). The CCA cohort had higher incidences of ascites (39.4 vs 27.4% P < 0.01, OR 1.72 95%CI 1.53–1.94), SBP (4.49 vs 2.76% P < 0.01, OR 1.66 95%CI 1.24–2.22), hepatorenal syndrome (5.99 vs 4.05% P < 0.01, OR 1.51 95%CI 1.17–1.94), and portal vein thrombosis (7.55 vs 2.01% P < 0.01, OR 3.99 95%CI 3.06–5.20). While the CCA cohort had a lower incidence of variceal bleeding (3.27 vs 4.73% P = 0.02, OR 0.68 95%CI 0.50–0.93), no difference between cohorts was found in the incidences of hepatic encephalopathy (17.2 vs 17.9% P = 0.58, OR 0.96 95%CI 0.82–1.11), and liver transplant rates (1.22 vs 0.80% P = 0.16, OR 1.54 95%CI 0.89-2.66). In a multivariate model, the presence of CCA was associated with higher hospital mortality (P < 0.01, aOR 1.41 95%CI 1.11–1.78) despite controlling for comorbidities and hepatic events. CONCLUSION: The presence of CCA in patients with cirrhosis is associated with increased hospital mortality and hepatic events, including ascites-related complications and PVT. These patients therefore require proactive surveillance of hepatic complications, followed by multidisciplinary management with oncology-hepatology specialty evaluation.Figure 1.: Multivariate model: the presence of cholangiocarcinoma is associated with increased mortality in hospitalized patients with cirrhosis.