S1099 Impact of Atrial Fibrillation on Inpatient Outcomes of Patients With Liver Cirrhosis: 2017-2018 National Inpatient Sample Database

Abstract

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in medical practice. We conducted this retrospective study to investigate an association between AF and liver cirrhosis (LC). Methods: The National Inpatient Sample database (2017 and 2018) was used for data analysis to identify patients with the principal diagnosis of LC and a secondary diagnosis of AF. We assessed the in-hospital mortality, length of stay, and total charge in liver cirrhosis patients with and without AF using multivariate logistic and linear regression analysis. Multiple confounders like Charlson comorbidity index (CCI), coronary artery disease, congestive heart failure, smoking, hyperlipidemia, alcohol intake, diabetes mellitus, obesity, myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, peripheral artery disease, gender, age, race, hospital region, hospital teaching status, hospital bed size, and patients economic status were included to adjust for biases. Results: 410824 patients were admitted with liver cirrhosis and 32866 had AF and LC. Mean LOS 5.67 days, mean age 57 years, and 39% female. AF increases odds of mortality in LC patients irrespective of all the confounders stated above (OR) 1.48, p = 0.000, 95% Confidence Interval (CI) 1.33 – 1.65. Factors contributing to higher odds of mortality include alcohol intake, age, weekend admission, patients admitted at teaching hospitals and a larger center. AF increases mean length of stay by 1.0 days in liver cirrhosis patients independent of all the confounders (p = 0.000, 95% CI 0.68 – 1.14). CHF, obesity, female gender, patients treated at teaching hospital, and patients treated at medium/large sized hospital increases mean LOS. AF increases mean total hospital charges by $14895 (p = 0.000, 95% CI 9591 – 7716) in liver cirrhosis patients. Patients treated at teaching hospital, and patients treated at medium/large sized hospital increases total charge (Table 1). Patients with a higher Charlson Comorbidity Index had increased odds of mortality, LOS, and total inpatient hospital charge. Conclusion: This study highlights the poor outcome of liver cirrhosis patients who develops atrial fibrillation. Limitation of this study includes retrospective analysis, the possibility of incomplete or misclassified diagnoses and unmeasured clinical variables skewing the outcomes that were not considered so larger prospective studies needs to be conducted to understand the outcomes clearly.Table 1.: Total Hospital Charge.