Letter to the Editor Open Access
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2023; 29(10): 1648-1650
Published online Mar 14, 2023. doi: 10.3748/wjg.v29.i10.1648
Reporting the cases of alcohol-associated hepatitis using the National Inpatient Sample data
Natalie Marlowe, Wei-Qi Lin, Durect Corporation, Cupertino, CA 95014, United States
Suthat Liangpunsakul, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, IN 46202, United States
ORCID number: Suthat Liangpunsakul (0000-0002-6504-8123).
Author contributions: Marlowe N and Lin WQ drafted the manuscript; Liangpunsakul S criticized and edited the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Suthat Liangpunsakul, MD, Full Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, 550 University Blvd, Indianapolis, IN 46202, United States. sliangpu@iu.edu
Received: October 25, 2022
Peer-review started: October 25, 2022
First decision: November 18, 2022
Revised: November 29, 2022
Accepted: March 2, 2023
Article in press: March 2, 2023
Published online: March 14, 2023
Processing time: 136 Days and 1.2 Hours

Abstract

The letter is to respond to the recent publication “Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study” (World J Gastroenterol 2022; 28: 5036-5046). We noticed a significant difference in the total numbers of reported hospitalized alcohol-associated hepatitis (AH) patients between this publication and our publication on Alcohol Clin Exp Res (2022; 46: 1472-1481). We believe the number of “AH-related hospitalizations” inflated by the inclusion of patients with non-AH forms of alcohol-associated liver disease.

Key Words: Hospitalization; Alcoholic hepatitis; Alcohol-associated liver disease

Core Tip: We analyzed the most recent National Inpatient Sample data from 2015-2019 using International Classification of Diseases-10 codes and found an increase in alcohol-associated hepatitis (AH) cases from 110135 to 136620 in 2015 and 2019, respectively. The total numbers of reported AH patients in the retrospective study entitled “Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study”, we believe, included patients with non-AH forms of alcohol-associated liver disease.



TO THE EDITOR

We read with great interest the retrospective study entitled “Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study” by Wakil et al[1]. In this study the authors examined inpatient admission trends for alcohol-associated hepatitis (AH), using the National Inpatient Sample (NIS) database data from 2011 to 2017. The study population were those with aged ≥ 21 years who were hospitalized with either a primary or secondary diagnosis of AH identified by the International Classification of Diseases (ICD)-9 and its corresponding ICD-10 codes.

The authors reported that AH-related hospitalization demonstrated a significant increase from 281506 in 2011 to 324050 hospitalizations in 2017 with an overall increase in the financial burden and cost. We agree with the authors’ opinion that AH-related hospitalizations are on the rise, and that they are associated with escalating healthcare costs and utilization. In fact, our recent paper published in Alcohol Clin Exp Res, 2022, came to the same conclusions when we analyzed the most recent NIS data for AH hospital discharges from 2015-2019 using a similar methodology[2]. However, we noticed a significant difference in the total numbers of reported AH patients between these studies. In our study, we reported an increase in total hospitalized AH cases from 110135 to 136620 in 2015 and 2019, respectively[2], which was consistent with another recent paper by Ali et al[3] in Annals of Gastroenterology, 2022. The numbers from both Ali et al[3] and our study were much smaller than the numbers quoted by Wakil et al[1]. The difference is explained by the ICD codes used in the studies. We included only patients hospitalized with or without cirrhosis under ICD-9 571.1 (AH) and ICD-10 K70.1 (AH with/without ascites). In contrast, Wakil et al[1] included patients admitted with AH, alcoholic fatty liver disease, and alcohol-associated cirrhosis [an advanced chronic form of associated liver disease (ALD)]. In our opinion, the number of “AH-related hospitalizations” reported by this study is inflated by the inclusion of patients with non-AH forms of ALD.

Alcohol use and ALD are global public health issues associated with high morbidity and mortality[4]. Retrospective studies investigating AH hospitalization trends and associated healthcare costs should be interpreted with caution because the results may be influenced significantly by the ICD codes used to identify AH patients. Reporting using the most appropriate codes is the best use of these large national databases.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country/Territory of origin: United States

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B

Grade C (Good): 0

Grade D (Fair): D

Grade E (Poor): 0

P-Reviewer: Jakovljevic MM, Serbia; Nishizawa T, Japan S-Editor: Wang JJ L-Editor: A P-Editor: Wang JJ

References
1.  Wakil A, Mohamed M, Tafesh Z, Niazi M, Olivo R, Xia W, Greenberg P, Pyrsopoulos N. Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study. World J Gastroenterol. 2022;28:5036-5046.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 1.0]  [Reference Citation Analysis (3)]
2.  Marlowe N, Lam D, Krebs W, Lin W, Liangpunsakul S. Prevalence, co-morbidities, and in-hospital mortality of patients hospitalized with alcohol-associated hepatitis in the United States from 2015 to 2019. Alcohol Clin Exp Res. 2022;46:1472-1481.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 8]  [Reference Citation Analysis (1)]
3.  Ali H, Pamarthy R, Bolick NL, Farooq MF. Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States. Ann Gastroenterol. 2022;35:427-433.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (2)]
4.  Jakovljevic M, Varavikova EA, Walter H, Wascher A, Pejcic AV, Lesch OM. Alcohol Beverage Household Expenditure, Taxation and Government Revenues in Broader European WHO Region. Front Pharmacol. 2017;8:303.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 5]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]