Trends in hospitalizations for chronic liver disease‐related liver failure in the United States, 2005‐2014

Abstract

Background & Aims Current estimates of the population‐based disease burden of liver failure or end‐stage liver disease (ESLD) are lacking. We investigated recent trends in hospitalizations and in‐hospital mortality among patients with ESLD in the United States (US). Methods A retrospective analysis was performed utilizing the National Inpatient Sample from 2005 to 2014. We defined ESLD as either decompensated cirrhosis or hepatocellular carcinoma (HCC), criteria obtained from the International Classification of Diseases, Ninth Revision. Nationwide rates of hospitalization and in‐hospital mortality were analysed from 2005 to 2014. Results Hospitalization rates for decompensated cirrhosis during this period increased from 105.3/100 000 persons to 159.9/100 000 persons. In terms of HCC, hospitalization rates increased from 13.6/100 000 to 22.1/100 000. In patients with non‐alcoholic fatty liver disease (NAFLD)‐related decompensated cirrhosis, the hospitalization rate increased from 13.4/100 000 to 32.1/100 000 with an annual incremental increase of 10.6%, a magnitude twofold higher than other aetiologies. The proportion of NAFLD among hospitalizations with ESLD steadily increased from 12.7% to 20.1% for decompensated cirrhosis while the proportion of chronic hepatitis C (HCV) and alcoholic liver disease (ALD) declined (from 29.3% to 27.6% for HCV; from 39.0% to 37.4% for ALD). Although the overall in‐hospital mortality rates for ESLD declined during the study, mortality rates for NAFLD‐related decompensated cirrhosis showed no significant change. Conclusions Among aetiologies of chronic liver disease, NAFLD demonstrated the fastest growing rate of hospitalizations in non‐HCC patients with ESLD in the US. Our study highlights the need for a focus on NAFLD‐related hospitalizations and its impact on resource utilization.

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

“…Genetic mutations in interaction with epigenetics and environmental factors, which may be present for Asians/Pacific Islanders, could also theoretically increase mortality in this patient group. Cirrhosis, especially with decompensation, has been known to increase in-hospital mortality for Asians/Pacific Islanders, which may also further explain our results [ 6 ].…”

“…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 ].…”

“…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 ].…”

“…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 ].…”

The Association between Meteorological Factors and the Prevalence of Acute-on-chronic Liver Failure: A Population-based Study, 2007–2016

“…3,9,18 A growing trend in the incidence of this fatal disease throughout the past decade has been observed in the USA. 2,18 In this study, although a different diagnostic criterion for ACLF was used, we also demonstrated a rise in the prevalence of ACLF in Southeastern China. Additionally, a correlation between the prevalence of ACLF and low temperature as well as high humidity was demonstrated in this study.…”