In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Table 1 Patient characteristics, in-hospital treatments, outcomes, and resource use in hospital admission for hepatorenal syndrome (mean ± SD)

	Unweighted, n (%)	Unweighted % ± SE	Weighted, n (%)	Weighted % ± SE
Total, n (%)	4938		23973
Sex
Male	3130	63.39 ± 0.68	15183	63.33 ± 0.31
Female	1808	36.61 ± 0.68	8790	36.67 ± 0.31
Age (yr)		58.8 ± 12.3		58.8 ± 12.3
18-39	266	5.39 ± 0.32	1299	5.42 ± 0.15
40-59	2461	49.84 ± 0.71	11933	49.77 ± 0.32
60-79	1927	39.02 ± 0.69	9365	39.06 ± 0.31
≥ 80	284	5.75 ± 0.33	1376	5.74 ± 0.15
Race
White	3098	72.23 ± 0.68	15050	72.12 ± 0.31
Black	421	9.81 ± 0.45	2055	9.85 ± 0.21
Hispanic	511	11.91 ± 0.49	2495	11.95 ± 0.22
Asian/Pacific islander	81	1.89 ± 0.21	395	1.89 ± 0.09
Native American	57	1.33 ± 0.17	280	1.34 ± 0.07
Other	121	2.82 ± 0.25	593	2.84 ± 0.11
Admission day
Weekday	3955	80.09 ± 0.57	19223	80.18 ± 0.26
Weekend	983	19.91 ± 0.57	4751	19.82 ± 0.26
Liver disease etiology
Alcoholic liver disease	2249	45.54 ± 0.71	10935	45.61 ± 0.32
Viral hepatitis	1218	24.66 ± 0.61	5915	24.67 ± 0.28
Comorbidities
Diabetes Mellitus	1260	25.52 ± 0.62	6132	25.58 ± 0.28
Hypertension	1937	39.23 ± 0.69	9437	39.36 ± 0.32
Fluid/electrolyte disorders	3548	71.85 ± 0.64	17233	71.88 ± 0.29
Coagulopathy	2115	42.83 ± 0.70	10286	42.90 ± 0.32
Anemia	1937	39.23 ± 0.69	9422	39.30 ± 0.31
Weight loss	872	17.66 ± 0.54	4255	17.75 ± 0.25
Cancer	658	13.32 ± 0.48	3198	13.34 ± 0.22
Congestive heart failure	630	12.76 ± 0.47	3042	12.69 ± 0.21
Chronic pulmonary disease	613	12.41 ± 0.47	2973	12.40 ± 0.21
Obesity	456	9.23 ± 0.41	2218	9.25 ± 0.19
Neurological disorders	234	4.74 ± 0.30	1147	4.78 ± 0.14
Pulmonary circulation disorders	176	3.56 ± 0.26	847	3.53 ± 0.12
Valvular disease	164	3.32 ± 0.25	795	3.32 ± 0.12
Peripheral vascular disorders	119	2.41 ± 0.22	587	2.45 ± 0.10
Depression	413	8.36 ± 0.39	2002	8.35 ± 0.18
HIV/AIDS	36	0.73 ± 0.12	173	0.72 ± 0.05
Substance use
Smoking	583	11.81 ± 0.46	2825	11.78 ± 0.21
Alcohol	1930	39.08 ± 0.69	9394	39.19 ± 0.31
Drug use	209	4.23 ± 0.29	1023	4.27 ± 0.13
Bed size
Small	611	12.30 ± 0.50	2898	12.09 ± 0.21
Medium	1210	24.41 ± 0.66	5905	24.63 ± 0.28
Large	3117	63.28 ± 0.74	15171	63.28 ± 0.31
Location/Teaching status
Rural	651	13.89 ± 0.53	3167	13.21 ± 0.22
Urban, non-teaching	1723	36.76 ± 0.74	8320	34.70 ± 0.31
Urban, teaching	2564	49.35 ± 0.77	12487	52.08 ± 0.32
Hospital region
Northeast	984	20.24 ± 0.62	4817	20.09 ± 0.26
Midwest	1122	23.03 ± 0.65	5406	22.55 ± 0.27
South	1699	34.03 ± 0.73	8261	34.46 ± 0.31
West	1133	22.70 ± 0.64	5489	22.90 ± 0.27
Medical procedures/interventions
Renal replacement therapy	1018	20.61 ± 0.58	4929	20.56 ± 0.26
Paracentesis	2226	45.08 ± 0.71	10843	45.23 ± 0.32
Mechanical ventilation	499	10.10 ± 0.43	2412	10.06 ± 0.19
TIPS	46	0.93 ± 0.14	218	0.91 ± 0.06
Liver transplantation	85	1.68 ± 0.18	404	1.68 ± 0.08
LTA	66	1.34 ± 0.16	321	1.34 ± 0.07
SLKT	19	0.38 ± 0.09	93	0.39 ± 0.04
Outcomes
Mortality	1573	31.90 ± 0.66	7616	31.81 ± 0.30
Length of hospital stay (d)		8.8 ± 10.9		8.8 ± 11.0
Hospitalization cost (United States $)		735701 ± 135526		73731 ± 135876

SE: Standard error; HIV/AIDS: Human immunodeficiency virus/acquired immunodeficiency syndrome; TIPS: Transjugular intrahepatic portosystemic shunt; LTA: Liver transplant alone; SLKT: Simultaneous liver-kidney transplantation.

Table 2 The annual trend in hospital mortality, liver transplantation, renal replacement therapy, length of hospital stay, hospitalization cost in hepatorenal syndrome admission from 2005 to 2014 (mean ± SD)

Year	Unweighted sample1	Weighted sample1	Hospital mortality weighted % ± SE	Liver transplantation weighted % ± SE	Renal replacement therapy weighted % ± SE	Length of stay (d)	Hospital cost (United States $)
Total	4931	23941	31.8 ± 0.7	1.7 ± 0.2	20.6 ± 0.6	8.8 ± 11.0	73731 ± 135876
2005	312	1471	43.8 ± 2.8	0.7 ± 0.5	13.8 ± 2.0	8.2 ± 8.6	42857 ± 67978
2006	330	1551	40.8 ± 2.7	0.6 ± 0.4	13.6 ± 1.9	7.2 ± 7.6	41841 ± 67254
2007	287	1358	36.7 ± 2.9	1.1 ± 0.6	17.0 ± 2.2	8.0 ± 8.9	49879 ± 77833
2008	367	1737	37.1 ± 2.5	1.9 ± 0.7	21.7 ± 2.2	8.6 ± 9.4	65419 ± 109901
2009	486	2363	31.1 ± 2.1	2.2 ± 0.7	20.8 ± 1.8	8.9 ± 11.3	71737 ± 123006
2010	610	2973	31.1 ± 1.9	0.9 ± 0.4	21.3 ± 1.7	9.3 ± 13.7	69778 ± 106971
2011	628	2934	30.3 ± 1.9	1.9 ± 0.5	23.3 ± 1.7	8.6 ± 9.6	82917 ± 154746
2012	603	3015	31.2 ± 1.9	2.0 ± 0.6	21.9 ± 1.7	9.1 ± 13.5	74951 ± 113671
2013	622	3110	28.3 ± 1.8	2.7 ± 0.7	21.4 ± 1.6	9.4 ± 12.1	95671 ± 210352
2014	686	3430	24.1 ± 1.6	1.7 ± 0.5	22.4 ± 1.6	9.0 ± 9.0	90829 ± 149495
P value			< 0.001	0.02	< 0.001	< 0.001	< 0.001

¹Sample of hepatorenal syndrome patients having complete data on mortality status.

SE: Standard error.

Table 3 Clinical characteristics associated with in-hospital mortality

Characteristics	Univariable analysis		Multivariable analysis
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Female sex	0.96 (0.85-1.09)	0.52	0.91 (0.78-1.07)	0.27
Age (yr)
18-39	1 (ref)	-	1 (ref)	-
40-59	1.21 (0.91-1.60)	0.19	1.45 (1.28-1.64)	< 0.001
60-79	1.24 (0.93-1.65)	0.14	1.77 (1.68-1.87)	< 0.001
≥ 80	1.68 (1.17-2.42)	0.005	2.12 (1.51-3.00)	< 0.001
Race
White	1 (ref)	-	1 (ref)	-
Black	1.38 (1.11-1.71)	0.003	1.26 (0.91-1.75)	0.16
Hispanic	1.05 (0.86-1.29)	0.61	1.12 (0.78-1.61)	0.53
Asian/Pacific Islander	1.44 (0.91-2.27)	0.12	1.30 (0.98-1.73)	0.07
Native American	1.04 (0.59-1.84)	0.88	1.11 (0.86-1.43)	0.43
Other	0.88 (0.59-1.32)	0.55	0.93 (0.48-1.81)	0.84
Weekend admission	1.14 (0.98-1.32)	0.08	1.05 (0.82-1.34)	0.69
Liver disease etiology
Alcohol-related	0.90 (0.80-1.01)	0.08	0.85 (0.71-1.01)	0.06
Viral hepatitis	0.98 (0.86-1.13)	0.83	1.00 (0.81-1.24)	1.00
Comorbidities
Smoking	0.96 (0.79-1.16)	0.66	1.15 (0.83-1.60)	0.40
Alcohol use	0.98 (0.87-1.11)	0.79	1.35 (1.26-1.45)	< 0.001
Drug use	0.84 (0.62-1.14)	0.26	0.77 (0.55-1.08)	0.13
HIV/AIDS	1.02 (0.51-2.07)	0.95	0.81 (0.58-1.13)	0.22
Autoimmune arthritis	1.10 (0.64-1.91)	0.73	1.14 (0.54-2.41)	0.72
Congestive heart failure	1.05 (0.88-1.26)	0.59	0.99 (0.87-1.12)	0.84
Chronic pulmonary disease	1.00 (0.84-1.21)	0.96	0.95 (0.78-1.16)	0.63
Coagulopathy	1.01 (0.90-1.15)	0.82	1.15 (1.16-1.25)	0.001
Diabetes mellitus	0.78 (0.67-0.89)	< 0.001	0.87 (0.73-1.04)	0.12
Hypertension	0.76 (0.67-0.86)	< 0.001	0.83 (0.70-1.01)	0.06
Lymphoma	1.42 (0.68-2.96)	0.35	1.53 (0.42-5.60)	0.52
Fluid/electrolyte disorders	0.85 (0.74-0.97)	0.02	0.87 (0.75-1.01)	0.07
Cancer	1.34 (1.13-1.59)	0.001	1.40 (0.88-2.23)	0.15
Neurological disorders	1.29 (0.98-1.70)	0.07	1.38 (1.21-1.58)	< 0.001
Obesity	0.87 (0.70-1.07)	0.20	0.92 (0.62-1.38)	0.70
Peripheral vascular disorders	0.78 (0.51-1.18)	0.23	0.78 (0.42-1.46)	0.44
Psychoses	0.80 (0.55-1.16)	0.24	0.93 (0.78-1.12)	0.44
Pulmonary circulation disorders	0.75 (0.53-1.05)	0.10	0.68 (0.43-1.08)	0.11
Valvular disease	0.75 (0.53-1.07)	0.12	1.01 (0.64-1.60)	0.96
Weight loss	0.91 (0.78-1.07)	0.27	1.05 (0.97-1.13)	0.21
Medical procedure
Renal replacement therapy	0.98 (0.85-1.14)	0.81	0.92 (0.68-1.25)	0.59
Liver transplantation	0.33 (0.23-0.46)	< 0.001	0.15 (0.11-0.21)	< 0.001
TIPS	0.40 (0.18-0.90)	0.03	0.23 (0.12-0.43)	< 0.001
Paracentesis	0.46 (0.41-0.53)	< 0.001	0.48 (0.43-0.53)	< 0.001
Mechanical ventilation	6.97 (5.66-8.59)	< 0.001	9.24 (7.90-10.81)	< 0.001

HIV/AIDS: Human immunodeficiency virus/acquired immunodeficiency syndrome; TIPS: Transjugular intrahepatic portosystemic shunt; OR: Odds ratio; 95%CI: 95% confidence interval.