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Abstract Details
In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample
World J Gastroenterol. 2021 Dec 7;27(45):7831-7843. doi: 10.3748/wjg.v27.i45.7831.
Wisit Kaewput1, Charat Thongprayoon2, Carissa Y Dumancas2, Swetha R Kanduri3, Karthik Kovvuru3, Chalermrat Kaewput4, Pattharawin Pattharanitima5, Tananchai Petnak6, Ploypin Lertjitbanjong7, Boonphiphop Boonpheng8, Karn Wijarnpreecha9, Jose L Zabala Genovez2, Saraschandra Vallabhajosyula10, Caroline C Jadlowiec11, Fawad Qureshi2, Wisit Cheungpasitporn12
Author information
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States.
Division of Nephrology, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States.
Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand.
Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand.
Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 13326, United States.
Division of Nephrology, University of Washington, Seattle, WA 98195, United States.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States.
Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States.
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, United States.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States. wcheungpasitporn@gmail.com.
Abstract
Background: Hepatorenal syndrome (HRS) is a life-threatening condition among patients with advanced liver disease. Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited.
Aim: To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States.
Methods: We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality. We estimated odds ratios from multi-level mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.
Results: Overall hospital mortality was 32%. Hospital mortality decreased from 44% in 2005 to 24% in 2014 (P < 0.001), while there was an increase in the rate of liver transplantation (P = 0.02), renal replacement therapy (P < 0.001), length of hospital stay (P < 0.001), and hospitalization cost (P < 0.001). On multivariable analysis, older age, alcohol use, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, transjugular intrahepatic portosystemic shunt, and abdominal paracentesis were associated with lower hospital mortality.
Conclusion: Although there was an increase in resource utilizations, hospital mortality among patients admitted for HRS significantly improved. Several predictors for hospital mortality were identified.
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