Kidney Week

Abstract: FR-PO141

National Trends in Hospitalization and Resource Utilization in the Hepatorenal Syndrome Population: 2005-2014

Session Information

• AKI Clinical: Outcomes and Biomarkers
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Charilaou, Paris, Saint Peter's University Hospital, New Brunswick, New Jersey, United States

Paris Charilaou,

• Devani, Kalpit, East Tennessee State University, Johnson City, Tennessee, United States

Kalpit Devani,

• De, Ayan, Saint Peter's University Hospital, New Brunswick, New Jersey, United States

Ayan De,

• Cornejo cobo, Alvaro, Saint Peter's University Hospital, New Brunswick, New Jersey, United States

Alvaro Cornejo cobo,

• Petrosyan, Romela, Greenville Memorial Hospital, Greenville, South Carolina, United States

Romela Petrosyan,

• Garcia, Pablo, Saint Peter's University Hospital, New Brunswick, New Jersey, United States

Pablo Garcia,

Background

Recent changes in guidelines for diagnosis and treatment of Hepatorenal Syndrome (HRS) could have potentially affected hospital outcomes in these patients. We analyzed hospitalization and outcome trends of HRS cases, as well as outcome predictors, in the US inpatient population from 2005 to 2014.

Methods

We included all adults from the National Inpatient Sample (2005-2014), excluding cases with missing data on age/gender/inpatient mortality, who had documented liver cirrhosis (571.2, 571.5, 571.6) and HRS (572.4) as any discharge diagnosis, using the International Classification of Diseases Revision 9 – Clinical Modification (ICD-9-CM) codes. Multivariable mixed-effects regression was used to assess hospitalization trends as well as predictors of mortality, length of stay (LOS), and hospitalization costs. National estimates were calculated.

Results

We identified 158,306 HRS discharges, with males (65.4%) and white race (66.4%) being the majority. HRS annual prevalence increased exponentially (adjusted-R²=0.99). Mean age was 57.6±0.08 years (increasing;p-trend<0.001). Mean mortality rate was 30.2% with decreasing trend (41% to 26.5%,p<0.001). Mean costs were unchanged at $31,061, as well as LOS (10.3 days), while aggregated costs increased by 2.5 times ($310.8 million in 2005 to $762.8 million in 2014). Significant (all p<0.001) mortality predictors included variceal bleed (aOR=1.90), hepatic encephalopathy (aOR=1.37), spontaneous bacterial peritonitis (aOR=1.42) and hepatocellular carcinoma (aOR=1.20). Urban and Midwest hospitals carried lower mortality risk (p<0.001). Urban and teaching hospitals exhibited longer LOS and higher costs. Midwest hospitals had 27% shorter LOS and 21% lower costs than the Northeast.

Conclusion

HRS hospitalizations are exponentially increasing, with an ever-growing financial burden to healthcare. While overall mortality is decreasing, there are disparities in hospitalization outcomes among regions.