The Clinical Impact of Cirrhosis on the Hospital Outcomes of Patients Admitted With Influenza Infection: Propensity Score Matched Analysis of 2011–2017 US Hospital Data

Abstract

Background/Objectives: Patients with cirrhosis have liver-related immune dysfunction that potentially predisposes the patients to increased influenza infection risk. Our study evaluates this cross-sectional relationship using a national registry of hospital patients. Methods: This study included the 2011-2017 National Inpatient Sample database. From this, respiratory influenza cases were isolated and stratified using the presence of cirrhosis into a cirrhosis-present study cohort and cirrhosis-absent controls; propensity score matching method was used to match the controls to the study cohort (cirrhosis-present) using a 1:1 matching ratio. The endpoints included mortality, length of stay, hospitalization costs, and influenza-related complications. Results: Following the match, there were 2,040 with cirrhosis and matched 2,040 without cirrhosis admitted with respiratory influenza infection. Compared to the controls, cirrhosis patients had higher in-hospital mortality (7.79 vs 3.43% p < 0.001, OR 2.38 95% CI 1.78-3.17), longer length of stay (7.25 vs 6.52 d p < 0.001), higher hospitalization costs ($70,009 vs $65,035 p < 0.001), and were more likely be discharged to a skilled nursing facility and home healthcare (vs routine home discharges). In terms of influenza-related complications, the cirrhosis cohort had higher rates of sepsis (29.8 vs 22% p < 0.001, OR 1.51 95% CI 1.31-1.74). In the multivariate regression analysis, cirrhosis was associated with higher mortality (p < 0.001, aOR 2.31 95% CI 1.59-3.35) and length of stay (p = 0.018, aOR 1.03 95% CI 1.01-1.06). In subgroup analysis of patients with decompensated (n = 597) versus compensated cirrhosis (n = 1443), those with decompensated cirrhosis had higher rates of in-hospital mortality (12.7 vs 5.75% p < 0.001, OR 2.39 95% CI 1.72-3.32), length of stay (8.85 vs 6.59 d p < 0.001), and hospitalization costs ($92,858 vs $60,556 p < 0.001). In the multivariate analysis, decompensated cirrhosis was associated with increased mortality (p < 0.001, aOR 2.86 95% CI 1. 90-4.32). Conclusion: This study shows the presence of cirrhosis to result in higher hospital mortality and postinfluenza complications in patients with influenza infection.

The clinical impact of chronic liver disease in patients undergoing transcatheter and surgical aortic valve replacement: Systematic analysis of the 2011–2017 US hospital database

“…Cross‐sectional analysis was conducted using data from the National Inpatient Sample (NIS) as described in our previous studies 19,20 . The NIS is derived from the billing data provided in the State Inpatient Databases (SID).…”

“…Prior studies conducted by the current authorship describe the method used by this study to cross‐reference between ICD‐9‐CM and ICD‐10‐CM, 19,20 both of which were used to search for study variables 24–26 . Variables were selected using a search engine that integrated official ICD‐9‐CM to ICD‐10‐CM conversion tables 27,28 .…”

“…As performed and described in our prior studies, 19,20 this study utilized a standardized method of statistical analysis that involves a priori propensity score matching and post‐match regression analysis of residual variables. In this study, a 3:1 ratio propensity score matching of patients without CLD and those with CLD was performed to reflect the prevalence of CLD in the selected patients that have undergone TAVR or SAVR.…”

Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score–matched analysis of 2011–2017 US hospitals

“…The data elements and characteristics of the National Inpatient Sample (NIS) were previously described in research involving the current set of coauthors. [15][16][17] The NIS represents 20% of inpatient hospitalizations in the United States, excluding care received at long-term acute care hospitals and rehabilitation facilities. The database is constructed and maintained by the Agency for Healthcare Research and Quality (AHRQ) as part of the Healthcare Cost and Utilization Project (HCUP).…”

Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

“…In addition, in 2015, the NIS database transitioned from ICD-9 to ICD-10. The standard guidelines for including these revisions have been followed in this study (11)(12) Previous studies with the same co-authors have detailed a similar data gathering process which allowed cross-referencing between ICD-9 or ICD-10 codes while limiting heterogeneity (13,14). The heterogeneity was reduced with a pre-programmed, shared database that used CM ICD-9 to 10 conversion tables for the diagnosis-related groups (DRG's).…”