Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2021; 27(45): 7831-7843
Published online Dec 7, 2021. doi: 10.3748/wjg.v27.i45.7831
In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample
Wisit Kaewput, Charat Thongprayoon, Carissa Y Dumancas, Swetha R Kanduri, Karthik Kovvuru, Chalermrat Kaewput, Pattharawin Pattharanitima, Tananchai Petnak, Ploypin Lertjitbanjong, Boonphiphop Boonpheng, Karn Wijarnpreecha, Jose L Zabala Genovez, Saraschandra Vallabhajosyula, Caroline C Jadlowiec, Fawad Qureshi, Wisit Cheungpasitporn
Wisit Kaewput, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
Charat Thongprayoon, Carissa Y Dumancas, Jose L Zabala Genovez, Fawad Qureshi, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
Swetha R Kanduri, Karthik Kovvuru, Division of Nephrology, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
Chalermrat Kaewput, Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand
Pattharawin Pattharanitima, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
Tananchai Petnak, Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Ploypin Lertjitbanjong, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 13326, United States
Boonphiphop Boonpheng, Division of Nephrology, University of Washington, Seattle, WA 98195, United States
Karn Wijarnpreecha, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
Saraschandra Vallabhajosyula, Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
Caroline C Jadlowiec, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, United States
Wisit Cheungpasitporn, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Kaewput W was responsible for interpretation of data, revising the article, final approval; Thongprayoon C, Dumancas CY, Kanduri SR, Kovvuru K, Pattharanitima P, Boonpheng B, and Zabala Genovez JL were responsible for acquisition of data, drafting the article; Petnak T, Lertjitbanjong P, and Wijarnpreecha K, Vallabhajosyula S, Jadlowiec CC, and Qureshi F were responsible for interpretation of data, revising the article, final approval; Cheungpasitporn W performed the overall supervision and final approval.
Institutional review board statement: The Mayo Clinic Institutional Review Board approved this study (IRB number 21-007353 and date of approval; July 27, 2021).
Informed consent statement: The Mayo Clinic institutional review board approved this study and exempted the need for informed consent because the data in NIS database was publicly available and de-identified.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: We conducted a retrospective cohort study of hospital admissions for HRS from 2005 to 2014 in the National Inpatient Sample (NIS) database (publicly available and de-identified).
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wisit Cheungpasitporn, FACP, Associate Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. wcheungpasitporn@gmail.com
Received: September 4, 2021
Peer-review started: September 4, 2021
First decision: October 16, 2021
Revised: October 24, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 7, 2021
Processing time: 89 Days and 13.9 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatorenal syndrome (HRS) is a serious complication of cirrhosis, associated with high morbidity, mortality, and resource utilizations. In recent decades, there have been significant advances in knowledge, treatment and optimal management of patients with HRS.

Research motivation

There has been improvement in overall care for patients with HRS. Data on trends of hospital mortality and resource utilization in hospital admissions for HRS were limited.

Research objectives

We aimed to evaluate patient characteristics, in-hospital treatments, mortality, resource use among hospital admissions for HRS s in the United States. We also assessed the temporal trend in mortality and identified the predictors for mortality.

Research methods

We used the national inpatient sample database to identify unweighted sample of 4938 hospital admissions primarily for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcome was the temporal trend in and predictors for hospital mortality. We estimated odds ratio from multi-level mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.

Research results

The 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). Multivariable analysis older age, alcohol abuse, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, TIPs, and abdominal paracentesis were associated with lower hospital mortality.

Research conclusions

Although there was an increase in resource utilizations, hospital mortality among hospital admissions for HRS significantly improved.

Research perspectives

These trends were likely related to increased utilization of liver transplantation which is the definitive treatment for HRS. Future studies are needed to understand if these trends are impacted by other factors such as facility performance, patient care teams, health insurance reimbursement policies, or other factors.