Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2022; 14(4): 766-777
Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.766
Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management, a nationwide analysis
Sophia Haroon Dar, Mehek Rahim, Davood K Hosseini, Khurram Sarfraz
Sophia Haroon Dar, Mehek Rahim, Davood K Hosseini, Khurram Sarfraz, Internal Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, United States
Author contributions: Dar SH decided topic, designed study, completed the analysis, wrote, edited, and finalized paper; Rahim M participated in editing and finalizing the paper; Hoesseini DK and Sarfraz K participated in writing the initial draft.
Institutional review board statement: This is a retrospective review on a national database and did not require IRB approval.
Informed consent statement: This project was done on a large database national inpatient sample and did not require individual patient consent as it is a publicly available database.
Conflict-of-interest statement: There are no known conflicts of interest.
Data sharing statement: No individual patient identifiers are present in the national database. Therefore, no individual can be traced.
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: Sophia Haroon Dar, MD, Doctor, Internal Medicine, Hackensack University Medical Center, 30 Prospect Avenue Department of Internal Medicine Hackensack University Medical Center Hackensack NJ, 70601, Hackensack, NJ 07601, United States. sophia.dar@hmhn.org
Received: November 8, 2021
Peer-review started: November 8, 2021
First decision: December 12, 2021
Revised: January 4, 2022
Accepted: March 7, 2022
Article in press: March 7, 2022
Published online: April 27, 2022
Processing time: 164 Days and 12.8 Hours
Abstract
BACKGROUND

Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs. To our knowledge, there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with ST-elevation myocardial infarction-related cardiogenic shock (SRCS).

AIM

To identify the factors that increase inpatient mortality, length of stay, and total hospital charges in patients with liver cirrhosis (LC) compared to those without LC.

METHODS

This study includes all adults over 18 from the National Inpatient Sample 2017 database. The study consists of two groups of patients, including SRCS with LC and without LC. Inpatient mortality, length of stay, and total hospital charges are the primary outcomes between the two groups. We used STATA 16 to perform statistical analysis. The Pearson's chi-square test compares the categorical variables. Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality, length of stay, and resource utilization.

RESULTS

This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample. The two groups are SRCS without LC (n = 758809) and SRCS with LC (n = 11920). The majority of patients were Caucasian in both groups (67% vs 72%). The mean number of patients insured with Medicare was lower in the LC group (60% vs 56%) compared to the other group, and those who had at least three or more comorbidities (53% vs 90%) were significantly higher in the LC group compared to the non-LC group. Inpatient mortality was also considerably higher in the LC group (28.7% vs 10.63%). Length of Stay (LOS) is longer in the LC group compared to the non-LC group (9 vs 5.6). Similarly, total hospital charges are higher in patients with LC ($147407.80 vs $113069.10, P ≤ 0.05). Inpatient mortality is lower in the early percutaneous coronary intervention (PCI) group (OR: 0.79 < 0.11), however, it is not statistically significant. Both early Impella (OR: 1.73 < 0.05) and early extracorporeal membrane oxygenation (ECMO) (OR: 3.10 P < 0.05) in the LC group were associated with increased mortality. Early PCI (-2.57 P < 0.05) and Impella (-3.25 P < 0.05) were also both associated with shorter LOS compared to those who did not. Early ECMO does not impact the LOS; however, it does increase total hospital charge (addition of $24717.85, P < 0.05).

CONCLUSION

LC is associated with a significantly increased inpatient mortality, length of stay, and total hospital charges in patients who develop SRCS. Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges. The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care. Patients with early PCI had both shorter LOS and reduced inpatient mortality, while early Impella was associated with increased mortality and shorter LOS. Early ECMO is associated with increased mortality and higher total hospital charges. This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.

Keywords: Gastroenterology; Hepatology; Liver; ST-elevation myocardial infarction; Cardiogenic Shock; Percutaneous coronary intervention; Impella; Extracorporeal membrane oxygenation

Core Tip: This paper was written to identify the predictors of mortality and the effect of liver cirrhosis on patients who develop ST-elevation myocardial infarction-related cardiogenic shock requiring interventional management. We reviewed the effect of liver cirrhosis on mortality, length of stay, and total hospital charges. We hope that this article will help build the foundation for future studies that will benefit this population of patients.