Abstract: FR-PO144

Hepatorenal Syndrome in Teaching versus Non Teaching Hospitals: A Nationwide Analysis

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Wen, Yumeng, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Pan, Di, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Mariuma, David, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Hernandez cuchillas, Marcelo Xavier, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Vazquez de lara, Fernando, Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
  • Gramuglia, Michael, Montefiore Medical Center, Scarsdale, New York, United States
  • Meisels, Ira S., Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, New York, United States
Background

Decompensated cirrhosis is a major cause of mortality and morbidity in the United States. Hepatorenal syndrome (HRS) is one of the potential causes of acute kidney injury (AKI) in patients with cirrhosis. The aim of our study is to determine the differences in outcomes and resource utilization in patients with HRS admitted to teaching hospitals as compared to nonteaching hospitals.

Methods

This is a retrospective cohort study using the 2014 National Inpatient Sample, the largest inpatient database in the United States. A corhort of 32,980 patients over the age of 18 diagnosed with HRS based on ICD-9 CM code was included in the study. Patients admitted for elective procedures were excluded. Hospitals were identified as teaching or nonteaching hospitals based on the American Hospital Association annual survey of hospitals. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity, as measured by the development of shock, acute respiratory failure, variceal bleed, requirement for dialysis and resource utilization, as measured by the length of hospital stay (LOS) and total hospital charges. Odds ratios (OR) were estimated based on multivariate regression model adjusted for demographics, hepatitis C status, hospital region, primary insurance and household income. Analysis was performed using Stata, Version 14.2. Group 1: HRS admission to teaching hospital. Group 2: HRS admission to nonteaching hospital.

Results

Among patients with HRS, the in-hospital mortality rates were not significantly different between the two groups (OR 1.06, p=0.38). However patients in teaching hospital had significantly higher rates of shock (OR 2.33, p<0.001), acute respiratory failure (OR 1.44, p<0.001), variceal bleeding (OR 1.54, p<0.05) and requirement for dialysis (OR 1.34, p<0.001). In teaching hospitals the total charges were $57711.91 more (p<0.001), and the length of stay was also greater (12.02 days vs. 8.07 days, p<0.001).

Conclusion

Patients with HRS admitted to teaching hospitals had significant increase in morbidities as compared to those admitted to non-teaching hospitals. The development of shock, acute respiratory failure, variceal bleed, the requirements for dialysis and resource utilizations were greater in teaching hospitals despite similar rates of mortality.