S1042 The Risk Factors Associated With Poor Prognosis in Hospitalized Patients With Acute Hepatitis A Infection: A Nationwide Analysis

Abstract

INTRODUCTION: Acute hepatitis A infections can result in severe liver injury and multiorgan failure. It is therefore important to identify the risk factors associated with inpatient mortality in order to stratify this population and provide risk-specific interventions. In this study, we used a national database to determine the risk factors associated with poor hospital prognosis in these patients. METHODS: Hospitalized patients with acute hepatitis A infection were selected from the 2011 to 2017 National Inpatient Sample and were stratified by survival status. Cirrhosis cases were excluded from the study. The deceased cohort was compared to the surviving cohort in terms of length of stay (LOS), hospitalization costs, hepatic events, and common comorbidities in order to identify risk factors associated with hospital mortality in these patients. RESULTS: A total of 11740 patients from the database were identified to have acute hepatitis A infection, of whom 114 (0.97%) were in the deceased cohort and 11626 were in the surviving cohort. In terms of demographics, the deceased cohort was older in age (71.1 vs 59.9y P < 0.01) and was more likely to be White or Asian/Pacific Islander (White 74.6 vs 66.1, Black 12.3 vs 19.2, Hispanic 5.26 vs 9.73, Asian or Pacific Islander 5.26 vs 1.70, other 2.63 vs 3.35% P = 0.02), but the cohorts were not different in terms of gender distribution (female: 51.8 vs 45.0% P = 0.18). The deceased cohort had higher LOS (13 vs 7.35d P < 0.01) and hospitalization costs ($155,523 vs $48,611 P < 0.01). In terms of hepatic events, the deceased cohort had higher incidences of ascites (7.02 vs 0.75% P < 0.01, OR 10.0 95%CI 4.73–21.2), hepatic encephalopathy (3.51 vs 0.37% P < 0.01, OR 9.80 95%CI 2.51–27.6), and liver failure (18.4 vs 1.11% P < 0.01, OR 20.1 95%CI 12.2–33.3). The deceased cohort also had higher incidence of sepsis (43 vs 7.86% P < 0.01, OR 8.84 95%CI 6.06–12.9), acute kidney injury (AKI) (57.9 vs 14.6% P < 0.01, OR 8.03 95%CI 5.52–11.7), and malnutrition (27.2 vs 6.55% P < 0.01, OR 5.33 95%CI 3.51–8.11). In a multivariate analysis, AKI (P < 0.01, aOR 4.34 95%CI 2.82–6.70) and sepsis (P < 0.01, aOR 4.66 95%CI 3.02–7.12) were strongly associated with increased hospital mortality. CONCLUSION: In hospitalized patients with acute hepatitis A infection, AKI and sepsis were associated with increased mortality. It is therefore important to identify these risk factors and provide early goal-directed therapies, including antibiotics and resuscitative therapy.Figure 1.: Multivariate model: acute kidney injury and sepsis are independent risk factors of mortality in hospitalized patients with acute hepatitis A infection.