Source

Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States.; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.

Abstract

BACKGROUND & AIMS:

Hepatic encephalopathy is a major complication of cirrhosis that causes substantial mortality and utilization of resources.

METHODS:

We analyzed 5 cycles of the Nationwide Inpatient Sample (NIS), conducted between 2005 and 2009, to determine national estimates of incidence, prevalence, inpatient mortality, severity of illness, and resource utilization for in-patients with hepatic encephalopathy.

RESULTS:

The yearly inpatient incidence of hepatic encephalopathy ranged from 20,918 (2005) to 22,931 (2009) (P =.2226), comprising approximately 0.33% of all hospitalizations in the US. Over the 5-year period of analysis, mortality of in-patients with hepatic encephalopathy remained relatively stable, at 14.13%-15.61% (P =.062); however, the proportion of patients with major and extreme severity of illness increased (P <.0001). The average length of inpatient stay increased from 8.1 to 8.5 days (P =0.019). The average total inpatient charges increased from $46,663 to $63,108 per case (P <.0001). Furthermore, total national charges related to hepatic encephalopathy increased from $4,676.7 million (2005) to $7,244.7 million (2009). In multivariate analysis, independent predictors of inpatient mortality included the number of diagnoses per admission (odds ratio [OR]=1.022; 95% confidence interval [CI], 1.016–1.029 per diagnosis), number of procedures per admission (OR=1.192 per procedure; 95% CI, 1.177-1.208), and major or extreme severity of illness (OR=3.16; 95% CI, 2.84-3.50). The most important predictors of cost, charge, and length of stay were admission to a large, urban hospital; use of Medicaid or Medicaid as the payer; major or extreme severity of illness; number of diagnoses at discharge; and procedures per admission (P <.05).

CONCLUSIONS:

Resource utilization increased from 2005 to 2009 for patients discharged from US hospitals with the diagnosis of hepatic encephalopathy. The inpatient mortality rate, however, remained stable, despite a trend toward more severe disease.