Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2022; 28(34): 5036-5046
Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.5036
Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study
Ali Wakil, Mujtaba Mohamed, Zaid Tafesh, Mumtaz Niazi, Raquel Olivo, Weiyi Xia, Patricia Greenberg, Nikolaos Pyrsopoulos
Ali Wakil, Zaid Tafesh, Mumtaz Niazi, Raquel Olivo, Nikolaos Pyrsopoulos, Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
Mujtaba Mohamed, Department of Gastroenterology and Hepatology, Marshall University Hospital, Huntington, WV 25701, USA
Weiyi Xia, Patricia Greenberg, Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
Author contributions: Wakil A contributed to the manuscript writing, methodology, editing, project administration; Mohamed M contributed to the manuscript writing and editing; Tafesh, Z, Olivo R and Niazi M contributed to the reviewing and editing; Greenberg P and Xia W contributed to the statistical analysis, data extraction; Pyrsopoulos N contributed to the supervision, reviewing and editing; all authors have read and approved the final manuscript.
Institutional review board statement: This study was done using the NIS database which does not require approval from the IRB, thus no IRB approval was needed for this study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data using NIS database which contains no identifying patient information and does not require informed consent to use the data.
Conflict-of-interest statement: All authors have no relevant conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos Pyrsopoulos, FAASLD, AGAF, FRCP, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, 185 S. Orange Avenue MSB H Rm - 536, Newark, NJ 07103, United States. pyrsopni@njms.rutgers.edu
Received: February 7, 2022
Peer-review started: February 7, 2022
First decision: April 10, 2022
Revised: May 1, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: September 14, 2022
Abstract
BACKGROUND

Severe alcoholic hepatitis (AH) is one of the most lethal manifestations of alcohol-associated liver disease. In light of the increase in alcohol consumption worldwide, the incidence of AH is on the rise, and data examining the trends of AH admission is needed.

AIM

To examine inpatient admission trends secondary to AH, along with their clinical outcomes and epidemiological characteristics.

METHODS

The National Inpatient Sample (NIS) database was utilized, and data from 2011 to 2017 were reviewed. We included individuals aged ≥ 21 years who were admitted with a primary or secondary diagnosis of AH using the International Classification of Diseases (ICD)-9 and its correspondent ICD-10 codes. Hepatitis not related to alcohol was excluded. The national estimates of inpatient admissions were obtained using sample weights provided by the NIS.

RESULTS

AH-related hospitalization demonstrated a significant increase in the USA from 281506 (0.7% of the total admission in 2011) to 324050 (0.9% of the total admission in 2017). The median age was 54 years. The most common age group was 45–65 years (range 57.8%–60.7%). The most common race was white (63.2%–66.4%), and patients were predominantly male (69.7%–71.2%). The primary healthcare payers were Medicare (29.4%–30.7%) and Medicaid (21.5%–32.5%). The most common geographical location was the Southern USA (33.6%–34.4%). Most patients were admitted to a tertiary care center (50.2%–62.3%) located in urban areas. Mortality of AH in this inpatient sample was 5.3% in 2011 and 5.5% in 2017. The most common mortality-associated risk factors were acute renal failure (59.6%–72.1%) and gastrointestinal hemorrhage (17.2%–20.3%). The total charges were noted to range between $25242.62 and $34874.50.

CONCLUSION

The number of AH inpatient hospitalizations significantly increased from 2011 to 2017. This could have a substantial financial impact with increasing healthcare costs and utilization. AH-mortality remained the same.

Keywords: Alcoholic hepatitis, Cirrhosis, Fatty liver disease, Alcohol abuse

Core tip: This study demonstrated a significant increase in the number of hospitalizations due to alcoholic-associated hepatitis (AH) throughout the USA, with an overall increase in the cost and financial burden of the disease. These trends were in line with the increase in the incidence of alcohol misuse across the years. This study provides potential data for future prospective research to help trigger more aggressive screening and prevention methods for alcohol abuse to prevent AH. Additionally, there is a need for the development of novel therapeutic agents targeting the disease since AH treatment is limited.