A Nationwide Study of Inpatient Admissions, Mortality, and Costs for Patients with Cirrhosis from 2005 to 2015 in the USA

Zou, Biyao; Yeo, Yee Hui; Jeong, Donghak; Park, Haesuk; Sheen, Edward; Lee, Dong Hoon; Henry, Linda; García, Gabriel; Ingelsson, Erik; Cheung, Ramsey; Nguyen, Mindie H.

doi:10.1007/s10620-019-05869-z

Cited by 29 publications

(36 citation statements)

References 19 publications

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“…However, this is not the same for patients with cirrhosis-related complications, as can be seen in our study as well. Patients with cirrhosis-related complications continue to experience higher mortality rates, increased hospital LOS, and greater total hospital charges for all complications [ 5 , 6 ]. Our study further shows that high-risk cirrhosis patient populations, such as our cohort with pulmonary hypertension, also continue to have significantly higher mortality that is further magnified in association with deadly cirrhosis-related complications [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with cirrhosis-related complications continue to experience higher mortality rates, increased hospital LOS, and greater total hospital charges for all complications [ 5 , 6 ]. Our study further shows that high-risk cirrhosis patient populations, such as our cohort with pulmonary hypertension, also continue to have significantly higher mortality that is further magnified in association with deadly cirrhosis-related complications [ 5 ]. In previous studies, cirrhosis has been shown to increase hospitalizations for white patients, females, and holders of public insurance (e.g., Medicare or Medicaid) [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Liver cirrhosis is the final and irreversible stage of chronic liver fibrosis. Many patients with cirrhosis develop complications, including ascites, hepatic encephalopathy, hepatorenal syndrome, portal hypertension, ascites, and variceal bleeding [ 5 ]. Alarmingly, cirrhosis is reported to account for almost 2% of all deaths worldwide, and it is the eighth leading cause of death in the USA [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Many patients with cirrhosis develop complications, including ascites, hepatic encephalopathy, hepatorenal syndrome, portal hypertension, ascites, and variceal bleeding [ 5 ]. Alarmingly, cirrhosis is reported to account for almost 2% of all deaths worldwide, and it is the eighth leading cause of death in the USA [ 5 , 6 ]. This disease is a major burden on the US healthcare system, with annual costs having increased from approximately 10,000 million US dollars in 2005 to 16,000 million US dollars in 2015 [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Alarmingly, cirrhosis is reported to account for almost 2% of all deaths worldwide, and it is the eighth leading cause of death in the USA [ 5 , 6 ]. This disease is a major burden on the US healthcare system, with annual costs having increased from approximately 10,000 million US dollars in 2005 to 16,000 million US dollars in 2015 [ 5 , 6 ]. This significant rise in costs is secondary to increased hospitalizations, a greater number of transplant evaluations, and surging levels of mortality from cirrhosis-related complications and decompensation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

et al. 2020

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Introduction There is a paucity of data on the influence of sex, race, insurance, pulmonary hypertension-related complications, and cirrhosis-related complications on mortality, hospital length of stay (LOS), and total hospital charges. The aim of this study was to identify risk factors in a national population cohort (in the USA) admitted to hospital between 2012 and 2017. Methods All patients aged > 18 years with pulmonary hypertension and cirrhosis, who had been admitted to hospital between 2012 and 2017, were identified from the US Nationwide Inpatient Sample (NIS), a large publicly available all-payer inpatient care database in the USA. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Results Our study identified 1,111,594 patients who had been discharged from hospital from 2012 to 2017. Of these patients, 355,455 were admitted with pulmonary hypertension, with 9.8% having cirrhosis as a complication ( n = 34,986). The analysis revealed that patients with both pulmonary hypertension and cirrhosis compared to patients with only pulmonary hypertension experience increased mortality, hospital LOS, total hospital charges, and pulmonary hypertension-related and cirrhosis-related complications. Independent positive predictors of mortality were Asian/Pacific Islander race and "other" insurance status (worker’s compensation; other US health benefits plans [CHAMPUS/TRICARE, CHAMPVA, Title V]). Independent positive predictors of increased hospital LOS were black race and "other" patients (more than one race/mixed). Independent positive predictors of increased total hospital charges were male gender, Hispanic ethnicity, Asian/Pacific Islander race, and other insurance status. Pulmonary hypertension-related complications (cor pulmonale, pulmonary embolism, hemoptysis, cardiac arrest, atrial fibrillation, ventricular tachycardia) and cirrhosis-related complications (ascites, hepatorenal syndrome, hepatic encephalopathy, variceal bleeding, portal hypertension) were independent positive predictors of mortality, hospital LOS, and total hospital charges. Conclusions Patients with pulmonary hypertension and cirrhosis have increased mortality and hospital utilization compared to patients with only pulmonary hypertension. We identified key drivers for these outcomes. Targeted interventions, such as novel medications, right-to-left shunts, more evaluations for lung transplantation, and reversal of pulmonary vacular remodeling, are needed for the subgroups identified in this study in order to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

et al. 2020

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Analysis of hope level and its influencing factors in patients with decompensated cirrhosis

Zhang

Xie

et al. 2022

Nursing Open

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Liver cirrhosis is a pathological stage characterized by diffuse fibrosis, pseudolobule formation, and intrahepatic and extrahepatic vascular proliferation. There are no obvious clinical symptoms during the compensatory period. However, the decompensated period is characterized by portal hypertension and severe liver dysfunction, and patients often die of multiple organ failure due to ascites, gastrointestinal bleeding, sepsis, hepatic encephalopathy, hepatorenal syndrome and canceration (Smith et al., 2019). According to the estimated global liver disease-related mortality in 2015, liver cirrhosis and liver cancer cause approximately 1.16 million and 780,000 deaths every year, ranking 11th and 16th worldwide, respectively; together, they account for 3.5% of total global deaths (Asrani et al., 2019). Because of the long course of disease, poor prognosis, multiple complications and high cost of treatment, patients with liver cirrhosis experience serious physical and mental problems; are prone to anxiety, depression and other negative emotions; and usually adopt negative coping mechanisms to deal with stress events. Such negative psychology may be a huge burden on

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Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta‐Analysis

et al. 2022

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Introduction With the global prevalence of liver cirrhosis rising, this systematic review aimed to define the perioperative risk of mortality in these patients following appendicectomy. Methods Systematic searches of Medline, EMBASE, Cochrane Library databases, ICTRP, and Clinical trials.gov were undertaken to identify studies including patients with cirrhosis undergoing appendicectomy, published since database inception to March 2021. Studies had to report mortality. Two review authors independently identified eligible studies and extracted data. Pooled analysis of in-patient and 30-day mortality was performed. Results Of the 948 studies identified, four were included and this comprised three nationwide database studies (USA and Denmark) and one multi-centre observational study (Japan). A total of 923 patients had cirrhosis and 167,211 patients did not. In-patient mortality ranged from 0 to 1.7% in patients with cirrhosis and 0.17 to 0.3% in patients without. 30-day mortality was 9% in patients with cirrhosis compared to 0.3% in those without. One study stratified cirrhotic patients into compensated and decompensated groups. In patients with compensated cirrhosis, mortality following laparoscopic appendicectomy (0.5%) was significantly lower than open appendicectomy (3.2%). The meta-analysis highlighted a tenfold increase in perioperative mortality in cirrhotic patients (OR 9.92 (95% CI 4.67 to 21.06, I2 = 28%). All studies reported an increased length of stay in patients with cirrhosis. Conclusion This review suggests that appendicectomy in the cirrhotic population is associated with increased mortality. LA may be safer in this population. Lack of information on cirrhosis severity and failure to control for age and co-morbidities make the results difficult to interpret. Further large population-based studies are required.

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A Nationwide Study of Inpatient Admissions, Mortality, and Costs for Patients with Cirrhosis from 2005 to 2015 in the USA

Cited by 29 publications

References 19 publications

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

Analysis of hope level and its influencing factors in patients with decompensated cirrhosis

Mortality Following Appendicectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta‐Analysis

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