Trends in Chronic Liver Disease-Related Hospitalizations: A Population-Based Study

Abstract

OBJECTIVES: In a population-based study, we examined time trends in chronic liver disease (CLD)-related hospitalizations in a large and diverse metroplex. METHODS: We examined all CLD-related inpatient encounters (2000–2015) in Dallas–Fort Worth (DFW) using data from the DFW council collaborative that captures claims data from 97% of all hospitalizations in DFW (10.7 million regional patients). RESULTS: There were 83,539 CLD-related hospitalizations in 48,580 unique patients across 84 hospitals. The age and gender standardized annual rate of CLD-related hospitalization increased from 48.9 per 100,000 in 2000 to 125.7 per 100,000 in 2014. Mean age at hospitalization increased from 54.0 (14.1) to 58.5 (13.5) years; the proportion of CLD patients above 65 years increased from 24.2% to 33.1%. HCV-related hospitalizations plateaued, whereas an increase was seen in hospitalizations related to alcohol (9.1 to 22.7 per 100,000) or fatty liver (1.4 per 100,000 to 19.5 per 100,000). The prevalence of medical comorbidities increased for CLD patients: coronary artery disease (4.8% to 14.3%), obesity (2.8% to 14.6%), chronic kidney disease (2.8% to 18.2%), and diabetes (18.0% to 33.2%). Overall hospitalizations with traditional complications of portal hypertension (ascites, varices, and peritonitis) remained stable over time. However, hospitalization with complications related to infection increased from 54.7% to 66.4%, and renal failure increased by sevenfold (2.7% to 19.5%). CONCLUSIONS: CLD-related hospitalizations have increased twofold over the last decade. Hospitalized CLD patients are older and sicker with multiple chronic conditions. Traditional complications of portal hypertension have been superseded by infection and renal failure, warranting a need to redefine what it means to have decompensated CLD.

Trends in the Burden of Chronic Liver Disease Among Hospitalized US Adults

“…The sample included CLD-related hospitalizations of US adults (aged Ն18 years) between January 1, 2012, and December 31, 2016. We defined CLD using a comprehensive review of ICD-9-CM codes based on prior published algorithms 14,15 from January 1, 2012, to September 30, 2015, and corresponding ICD-10-CM codes starting October 1, 2015 (eFigure and eTable 1 in the Supplement).…”

Chronic Liver Disease and Silymarin: A Biochemical and Clinical Review

“…1 The increasing numbers of patients at risk for cirrhosis and in need of liver transplantation have become important economic and health concerns, with studies showing hospitalizations due to CLD having doubled in number over the last decade. 2,3 Therefore, there is a need for affordable and effective treatment modalities to reduce the morbidity and mortality associated with CLD. 4 Certain medicinal plants, such as Silybum marianum, more commonly known as milk thistle, have historically been used for the treatment and prevention of liver disorders.…”

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

“…Deaths due to cirrhosis have risen by at least 65% since 2009, and hospitalization rates for cirrhosis now exceed those for congestive heart failure. (1,2) Complicating the increasing burden of cirrhosis is the complexity of the condition and its medical management. (3) Ascites requires close monitoring, dietary modification, and adjunctive diuretic therapy that requires frequent dose adjustment; hepatic encephalopathy is often unpredictable, reduces one's ability to effectively self-care, yet depends on insight regarding one's symptoms to guide frequent lactulose dose adjustment; pain is frequently comorbid, and concerns over medication safety increase anxiety while limiting the efficacy of pain-control strategies.…”