Factors affecting mortality and resource use for hospitalized patients with cirrhosis: A population-based study

Journal article

Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis.Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013.The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P < .001). Complications of portal hypertension were independently associated with increased in-hospital mortality except for ascites. The highest independent risk for hospital death was seen with hepatorenal syndrome (odds ratio [OR], 5.04; 95% confidence interval [CI], 4.38-5.79). Mortality rate remained high in patients with infection, particularly septicemia (OR, 4.26; 95% CI, 4.0-4.54) and pneumonia (OR, 2.44; 95% CI, 2.18-2.73). Receiving upper endoscopy (OR, 0.29; 95% CI, 0.27-0.32) and paracentesis (OR, 0.93; 95% CI, 0.87-1.00) were associated with improved patient survival. The inflation-adjusted national annual costs (P = .06) and total hospital days (P = .07) for cirrhosis showed a trend toward increasing during the 5-year period. Renal dysfunction, infection, and sequelae of portal hypertension except for ascites were independently associated with increased resource utilization.Renal dysfunction, infection, and portal hypertension-related complications are the main factors affecting in-hospital mortality and resource utilization for hospitalized patients with cirrhosis. The early intervention for modifiable factors is an important step toward improving hospital outcomes.

Authors: Charatcharoenwitthaya, P; Soonthornworasiri, N; Karaketklang, K; Poovorawan, K; Pan-Ngum, W

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lippincott, Williams and Wilkins
• Journal: Medicine
• Volume: 96
• Issue: 32
• Pages: e7782
• Publication date: 2017-08-11
• Acceptance date: 2017-07-25
• DOI: 10.1097/md.0000000000007782
• EISSN: 1536-5964
• ISSN: 0025-7974
• Pmid: 28796076
• Language: English
• Keywords: cirrhosis; mortality; resource utilization; portal hypertension