The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Abstract

Objectives: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals. Method: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009-June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk. Results: A total of 2,542 patients hospitalized with HRS were identified (average age ¼ 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5 days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality. Conclusion: HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.

Predicting mortality for hepatorenal syndrome with liver‐specific scores

“…Although terlipressin costs significantly more than norepinephrine, the final cost of norepinephrine has been shown to be higher than terlipressin 16,42 as its use requires monitoring in an intensive care unit. Even where terlipressin is not available, such as the United States, the cost of the treatment of HRS is a major concern 43,44 . In the end, only LT can be considered as a definitive treatment for HRS, which actually increases survival in the long term and reduces the need for renal replacement therapy (RRT,17).…”

“…Even where terlipressin is not available, such as the United States, the cost of the treatment of HRS is a major concern. 43,44 In the end, only LT can be considered as a definitive treatment for HRS, which actually increases survival in the long term and reduces the need for renal replacement therapy (RRT,17).…”

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

“…The complications hepatorenal syndrome, pulmonary embolism, hemoptysis, and ventricular tachycardia also significantly worsened mortality, but to a lesser extent than cardiac arrest, and they also simultaneously increased hospital LOS and total hospital charges. Hepatorenal syndrome is the most lethal complication of cirrhosis, with patients having a 37% mortality rate; this condition almost always requires hospitalization and is associated with the worst prognosis [ 17 ]. Pulmonary embolism leads to chronic thromboembolic pulmonary hypertension in up to 3.8% of survivors of acute pulmonary embolism [ 18 ].…”

Review of the Literature on the Costs Associated With Acute Kidney Injury

“…A recent retrospective cohort study using a large US database from 2009-2015 was conducted to assess financial burden of patients with hepatorenal syndrome in the hospital setting. 45 ICD9 costs were used to identify hepatorenal syndrome (HRS) patients, and 634 patients had hospital charges associated with their stay. Authors decided to use hospital charge and they did not convert this figure to estimated costs The overall mean charge was $91,504.…”