S1151 In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A Six-Year Population Cohort Study of Over One Million Patients

Abstract

INTRODUCTION: There is a scarcity of data regarding the influence of sex, race, insurance, and PH-related and cirrhosis-related complications on mortality, hospital length of stay (LOS), and total hospitalization charges. In this study, we aim to identify risk factors in a national population cohort admitted from 2012 to 2017. METHODS: All patients >18 years old with pulmonary hypertension (PH) and cirrhosis admitted were identified from the Nationwide Inpatient Sample (NIS). 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, primary insurance payer, hospital type, hospital bed size, hospital region, hospital teaching status, mortality rate, length of stay, associated charges, and demographic characteristics. RESULTS: Overall sample included 1,111,594 patients. 355,455 patients were admitted with PH, of which 3% were complicated with cirrhosis (n = 34,986). Patients with PH and cirrhosis compared to patients with only PH have increased mortality, hospital LOS, total hospital charges, and PH-related and cirrhosis-related complications. Independent positive predictors of mortality were Asian/Pacific Islander race, other insurance status. Independent positive predictors of increased hospital LOS were black race, other patients. Independent positive predictors of increased total charges were male gender, Hispanic ethnicity, Asian/Pacific Islander race, other insurance status; independent negative predictors were Medicaid insurance, self-pay for insurance, and no charge insurance. PH-related [cor pulmonale, PE, hemoptysis, cardiac arrest, atrial fibrillation, ventricular tachycardia] and cirrhosis-related complications [ascites, hepatorenal syndrome, hepatic encephalopathy (HE), variceal bleeding, portal hypertension] were independent positive predictors of: mortality, hospital LOS, and total hospital charges. CONCLUSION: PH and cirrhosis lead to increased mortality and hospital utilization compared to patients with only PH. We identified key drivers for these outcomes. Targeted interventions are needed for the subgroups identified in this study. PH and cirrhosis can often coexist due to complex pulmonary-hepatic interactions, but these patients are very ill and at high-risk for complications. In the future, it is critical to better understand the complex pathophysiological relationship between these two diseases with randomized controlled trials and further studies.