Internal medicine hospitalisations and liver disease: a comparative disease burden analysis of a multicentre cohort

Abstract

Summary Background Liver disease is an increasing burden on population health globally. Aims To characterise burden of liver disease among general internal medicine inpatients at seven Toronto‐area hospitals and compare it to other common medical conditions. Methods Data from April 2010 to October 2017 were obtained from hospitals participating in the GEMINI collaborative. Using these cohort data from hospital information systems linked to administrative data, we defined liver disease admissions using most responsible discharge diagnoses categorised according to international classification of diseases, 10th Revision—enhanced Canadian version (ICD‐10‐CA). We identified admissions for heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia as comparators. We calculated standardised mortality ratios (SMRs) as the ratio of observed to expected deaths. Results Among 239 018 discharges, liver disease accounted for 1.7% of most responsible discharge diagnoses. Liver disease was associated with marked premature mortality, with SMR of 8.84 (95% CI 8.06‐9.67) compared to 1.06 (95% CI 0.99‐1.12) for heart failure, 1.05 (95% CI 0.96‐1.15) for COPD and 1.28 (95% CI 1.20‐1.37) for pneumonia. The majority of deaths were among patients younger than 65 years (57.7%) compared to 3.3% in heart failure, 5.6% in COPD and 10.7% in pneumonia. Liver disease patients presented with worse Laboratory‐Based Acute Physiology Scores, were more frequently admitted to the intensive care unit (14.4%), incurred higher average total costs (median $6723 CAD), had higher in‐hospital mortality (11.4%), and were more likely to be a readmission from 30 days prior (19.8%). Non‐alcoholic fatty liver disease admissions increased from 120 in 2011‐2012 to 215 in 2016‐2017 (P < 0.01). Conclusion In Canada's largest urban centre, liver disease admissions resulted in premature morbidity and mortality with higher resource use compared to common cardio‐respiratory conditions. Re‐evaluation of approaches to caring for inpatients with liver disease is timely and justified.

Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II)

“…However, the cohorts for the majority of these studies captured the readmission rates of all patients with cirrhosis, while this study focused on those with HE (known to increase the likelihood of rehospitalisation). Taken together with previous observations of reduced HCRU post-RFX initiation,16 17 the combined benefit of low recurrence of HE episodes, low number of complications and observed low rates of HCRU (outside of outpatient visits) support the rationale that RFX may provide a long-term economic benefit 14 31…”

“…Alternatively, the rates of complications could positively relate to the observed levels of alcohol abstinence (82%–87% between year 1 and year 5) in the ARLD cohort in which a low rate of complications might also be expected 28. Published rates of 30-day readmission due to liver-related causes vary between 18% and 37% and thus the observed rate of 37% between 1 and 5 years is at the higher end of this range 7 29–31. However, the cohorts for the majority of these studies captured the readmission rates of all patients with cirrhosis, while this study focused on those with HE (known to increase the likelihood of rehospitalisation).…”

Priority actions for elevating liver health in Canada: A call to action

“…Recently, it has been found that up to 27% of CLD patients have fibrosis at diagnosis, paralleling the rising incidence of cirrhosis among Canadian adults and children over the last decade (7,8). Just as alarming, a recent study of Toronto-area hospitals shows internal medicine hospitalizations for CLD outranked other major cardio-pulmonary conditions in rates of mortality, admissions, and hospitalization costs (9). Furthermore, although the incidence of HCC in Canada is relatively low, it has been associated with the largest increase in mortality rate of all cancers.…”

A simplification of the Kaiser Permanente inpatient risk adjustment methodology accurately predicted in-hospital mortality: A retrospective cohort study

“…This is problematic for implementing the KP method in other settings, because there are numerous troponin I assays and a separate troponin T assay, with varying reference ranges. Linear correlation between these assays does allow some standardization of troponin results, enabling the implementation of LAPS and LAPS2 [8][9][10]. However, new high-sensitivity cardiac troponin assays were introduced in 2010 and have replaced the older troponin assays in many healthcare institutions [11].…”