Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2019; 11(1): 74-85
Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.74
Temporal trends of cirrhosis associated conditions
Tomoki Sempokuya, Guangxiang Zhang, Kazuma Nakagawa
Tomoki Sempokuya, Guangxiang Zhang, Kazuma Nakagawa, Department of Internal Medicine, the Queen’s Medical Center, Honolulu, HI 968132, United States
Author contributions: Sempokuya T conception and designed the study, acquired data, drafted and edited this manuscript, Zhang G performed statistical analysis and interpretation of data, drafted and edited the manuscript and Nakagawa K supervised the study and edited the manuscript.
Institutional review board statement: This study utilized publicly-accessible, de-identified administrative level; aggregate data, rather than patient-specific data, approval from the institutional review board was not required to conduct the study.
Institutional animal care and use committee statement: No animal subjects were utilized in this study, so involvement was not needed.
Conflict-of-interest statement: All authors disclose no conflict of interest.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have carefully reviewed the ARRIVE guidelines, and the manuscript was prepared and edited in accordance to the ARRIVE guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Tomoki Sempokuya, MD, Doctor, Department of Internal Medicine, the Queen’s Medical Center, 1356 Lusitana Street, 7th Floor, 702, Honolulu, HI 96813, United States. tsempoku@hawaii.edu
Telephone: +1-808-5862910 Fax: +1-808-5867486
Received: October 12, 2018
Peer-review started: October 15, 2018
First decision: November 1, 2018
Revised: December 29, 2015
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 27, 2019
Processing time: 107 Days and 21.9 Hours
Abstract
BACKGROUND

Chronic liver disease and cirrhosis is the 12th leading cause of death in the United States. Patients with decompensated-cirrhosis, especially with hepatic encephalopathy/coma (HC), have a higher rate of early readmission and contribute to higher healthcare cost.

AIM

To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis.

METHODS

The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant.

RESULTS

From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357% (P < 0.0001) in comparison to HC not related to viral hepatitis by 33 % (P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3% (P = 0.95).

CONCLUSION

The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased.

Keywords: Cirrhosis; Hepatic encephalopathy; Spontaneous bacterial peritonitis; Esophageal varices; Transjugular intrahepatic portosystemic shunt

Core tip: Understanding recent temporal trends of cirrhosis-associated conditions is an important aspect of developing strategies to reduce health care cost. Our study showed increasing trends of hospital discharges related to cirrhosis-associated conditions despite the decreasing trends for total hospital discharges across the nation. Importantly, hepatic coma associated with viral hepatitis showed rapid increase in discharge volume in comparison to hepatic coma not associated with viral hepatitis. After adjusting for inflation, cirrhosis associated conditions showed disproportionately greater increase in aggregate cost compare to national trends. This suggests that prevention of hospitalizations secondary to cirrhosis-associated conditions likely reduces overall health care cost.