Mortality and health care burden of Budd Chiari syndrome in the United States: A nationwide analysis (1998-2017)

Table 1 Characteristics of patients and hospitals and individual effects on mortality, length of stay and total charges

Study time period	1998-2017	Individual effect (Type III test, P value)
		Mortality	Length of stay	Total charges
BCS patients' characteristics
Age	50.50 (0.19)	< 0.001	0.052	< 0.001
Female	55.19 (0.54)	0.003	0.001	< 0.001
Race		0.138	0.013	< 0.001
1: White	56.03 (0.54)
2: Black	13.26 (0.37)
3: Hispanic	9.56 (0.32)
4: Asian/Pacific Islander	2.56 (0.17)
6: Other	3.65 (0.2)
9: Unknown	14.93 (0.39)
Primary payer		< 0.001	0.002	< 0.001
1: Medicare	33.17 (0.52)
2: Medicaid	18.42 (0.42)
3: Private insurance	40.20 (0.54)
6: Other	8.21 (0.3)
Hospital characteristics
Hospital size		0.014	< 0.001	< 0.001
1: Small	9.81 (0.32)
2: Medium	18.92 (0.43)
3: Large	71.27 (0.49)
Hospital location and teaching status		0.195	< 0.001	< 0.001
1: Rural	6.89 (0.28)
2: Urban nonteaching	24.24 (0.47)
3: Urban teaching	68.87 (0.51)
Hospital region		0.533	0.010	< 0.001
1: Northeast	21.84 (0.45)
2: Midwest	22.15 (0.46)
3: South	33.45 (0.52)
4: West	22.57 (0.46)
Clinical characteristics
Ascites	29.93 (0.5)	< 0.001	< 0.001	< 0.001
Acute kidney injury	18.84 (0.43)	< 0.001	< 0.001	< 0.001
Hepatic cirrhosis with no mention of alcohol	18.65 (0.43)	0.901	0.031	0.838
Cancer	17.26 (0.41)	< 0.001	0.002	0.010
Portal hypertension	16.57 (0.41)	0.029	0.898	0.000
Hepatic encephalopathy	9.59 (0.32)	< 0.001	< 0.001	< 0.001
Portal vein thrombosis	7.92 (0.3)	0.006	0.372	0.073
Esophageal varices without bleeding	7.44 (0.29)	0.002	0.324	0.091
Acute respiratory Failure	7.03 (0.28)	< 0.001	< 0.001	< 0.001
HCC	6.93 (0.28)	< 0.001	< 0.001	0.543
Acute blood loss anemia/hemorrhagic	6.62 (0.27)	0.008	< 0.001	< 0.001
IVC thrombosis	6.39 (0.27)	< 0.001	< 0.001	< 0.001
Sepsis	6.10 (0.26)	< 0.001	< 0.001	< 0.001
Alcoholic cirrhosis	5.73 (0.25)	0.113	0.731	0.140
Acute liver failure	5.60 (0.25)	< 0.001	< 0.001	< 0.001
Hepatorenal syndrome	3.29 (0.2)	< 0.001	< 0.001	< 0.001
Variceal bleeding	3.20 (0.19)	0.107	0.160	0.001
Spontaneous bacterial peritonitis	2.83 (0.18)	< 0.001	< 0.001	< 0.001
Intestinal infarct/acute vascular insufficiency	2.11 (0.16)	< 0.001	< 0.001	< 0.001
Elixhauser Comoridity Score excluding liver disease	9.38 (0.12)	< 0.001	< 0.001	< 0.001

All data are presented as percentage (SE) for categorical variables and mean (SE) for continuous variables. BCS: Budd Chiari syndrome; HCC: Hepatocellular carcinoma IVC: Inferior vena cava.

Table 2 Trends in outcomes of interest

	1998-2017 (unweighted: 8435, weighted: 41119)	1998 (unweighted: 262, weighted: 1367)	2017 (unweighted: 680, weighted: 3400)	APC (95%CI)	P value for APC
Procedures
Number of procedures	2.64 (0.03)	3.09 (0.20)	2.42 (0.13)	-0.51% (-1.09%, 0.06%)	0.082
Paracentesis	18.41 (0.42)	28.56 (2.82)	16.47 (1.42)	-1.67% (-2.53%, -0.81%)	0.000
Upper endoscopy	10.94 (0.34)	13.08 (2.06)	11.91 (1.24)	-0.17% (-1.31%, 0.97%)	0.766
Liver biopsy	6.24 (0.26)	10.35 (1.9)	5.15 (0.85)	-4.01% (-5.42%, -2.58%)	< 0.0001
Portosystemic shunt/TIPS	3.63 (0.2)	6.12 (1.54)	2.94 (0.65)	-4.95% (-6.78%, -3.09%)	< 0.0001
Liver transplantation	1.9 (0.15)	1.29 (0.75)	2.06 (0.54)	-2.68% (-5.26%, -0.02%)	0.048
Disposition of patient
1: Discharged to home or selfcare	58.8(0.54)	50.71 (3.12)	55.96 (1.91)	-0.28% (-0.77%, 0.21%)	0.262
6: Home health care	13.49 (0.37)	12.04 (2.04)	17.23 (1.45)	3.31% (2.20%, 4.43%)	< 0.0001
5: Transfer: other type of facility	11.12 (0.34)	10.21 (1.89)	12.08 (1.25)	1.87% (0.70%, 3.06%)	0.002
20: Died in hospital	8.74 (0.31)	18.17 (2.44)	7.66 (1.02)	-4.31% (-5.50%, -3.10%)	< 0.0001
2: Transfer: short-term hospital	6.8 (0.28)	8.25 (1.71)	5.6 (0.88)	-1.26% (-2.66%, 0.17%)	0.084
7: Against medical advice	1 (0.11)	0.61 (0.43)	1.47 (0.46)	2.94% (-1.02%, 7.07%)	0.148
Outcomes
Number of deaths	737 (Unweighted); 3591 (Weighted)	46 (Unweighted); 249 (Weighted)	52 (Unweighted); 260 (Weighted)
Mortality rate per 1000000 United States populations		0.9	0.8	-0.29% (-0.86%, 0.27%)	0.309
Mortality rate per 1000000 inpatients		8.87	8.55	0.34% (-0.23%, 0.92%)	0.243
Mortality rate among BCS inpatients	0.09	0.18	0.08	-4.41% (-4.95%, -3.88%)	< 0.0001
Length of stay (d)	8.84 (0.13)	12.73 (1.01)	7.64 (0.36)	-2.04% (-2.67%, -1.41%)	< 0.0001
Average total charges in 2017 dollars	94440.04 (1996.06)	95515.01 (9483.24)	103850.98 (8183.79)	1.15% (0.35%, 1.96%)	0.005

All data are presented as percentage (SE) for categorical variables and mean (SE) for continuous variables. Annual percentage change (APC) > 0 means increasing, < 0 means decreasing. P value for APC measures if APC is significantly different from zero. P value ≤ 0.05 means the change is significant. BCS: Budd Chiari syndrome; APC: Annual percentage change.

Table 3 Multivariate model on mortality

	Response	Beta estimate	Standard error	P value for beta	Odds ratio (95%CI)
Age		0.024	0.003	< 0.0001	1.024 (1.019, 1.029)
Acute respiratory Failure	Yes (reference = No)	1.652	0.109	< 0.0001	5.219 (4.211, 6.468)
Intestinal infarct/acute vascular insufficiency	Yes (reference = No)	1.422	0.201	< 0.0001	4.143 (2.795, 6.142)
Acute liver failure	Yes (reference = No)	1.286	0.119	< 0.0001	3.617 (2.864, 4.567)
Hepatorenal syndrome	Yes (reference = No)	1.123	0.147	< 0.0001	3.072 (2.302, 4.101)
Cancer	Yes (reference = No)	0.882	0.098	< 0.0001	2.415 (1.993, 2.927)
Acute kidney injury	Yes (reference = No)	0.803	0.092	< 0.0001	2.232 (1.862, 2.675)
Sepsis/severe sepsis/septic shock	Yes (reference = No)	0.635	0.122	< 0.0001	1.886 (1.484, 2.398)
Hepatic encephalopathy	Yes (reference = No)	0.280	0.117	0.020	1.323 (1.052, 1.662)
Elixhauser Comorbidity Score excluding liver disease		0.026	0.004	< 0.0001	1.027 (1.019, 1.034)

Table 4 Multivariate model on length of stay

	Response	Beta estimate	Standard error	P value for Beta	P value for type 3 test
Primary payer	1: Medicare (reference)	0.000	-	-	0.022
	2: Medicaid	0.053	0.037	0.144
	3: Private insurance	0.084	0.030	0.005
Hospital bed size	1: Small (reference)	0.000	-	-	< 0.0001
	2: Medium	0.113	0.049	0.021
	3: Large	0.293	0.042	<.0001
Hospital location and teaching status	1: Rural (reference)	0.000	-	-	< 0.0001
	2: Urban nonteaching	0.206	0.054	<.0001
	3: Urban teaching	0.433	0.050	<.0001
Hospital region	1: Northeast	0.171	0.038	<.0001	< 0.0001
	2: Midwest	0.017	0.038	<.0001
	3: South	0.055	0.034	<.0001
	4: West (reference)	0.000
Complications
Acute liver failure	Yes (reference = No)	0.223	0.057	< 0.0001	< 0.0001
Acute respiratory Failure	Yes (reference = No)	0.380	0.052	< 0.0001	< 0.0001
Acute kidney injury	Yes (reference = No)	0.255	0.035	< 0.0001	< 0.0001
Ascites	Yes (reference = No)	0.118	0.028	< 0.0001	< 0.0001
Spontaneous bacterial peritonitis	Yes (reference = No)	0.480	0.076	< 0.0001	< 0.0001
IVC thrombosis	Yes (reference = No)	0.138	0.052	0.008	0.008
Intestinal infarct/acute vascular insufficiency	Yes (reference = No)	0.383	0.088	< 0.0001	< 0.0001
cancer	Yes (reference = No)	-0.278	0.036	< 0.0001	< 0.0001
Elixhauser Comorbidity Score excluding liver disease		0.019	0.001	< 0.0001	< 0.0001

IVC: Inferior vena cava.

Table 5 Multivariate model on total charges

	Response	Estimate	Standard error	P value for beta	P value for type 3 test
Race	1: White (reference)	0.000	-	-	< 0.0001
	2: Black	-0.037	0.026	0.162
	3: Hispanic	0.015	0.031	0.613
	4: Asian/Pacific Islander	0.136	0.058	0.019
	6: Other	0.082	0.046	0.077
	9: Unknown	-0.185	0.025	< 0.0001
Hospital bed size	1: Small (reference)	0.000	-	-	< 0.0001
	2: Medium	0.080	0.034	0.018
	3: Large	0.169	0.029	< 0.0001
Hospital location and teaching status	1: Rural (reference)	0.000	-	-	< 0.0001
	2: Urban nonteaching	0.428	0.037	< 0.0001
	3: Urban teaching	0.552	0.034	< 0.0001
Hospital region	1: Northeast	-0.195	0.027	< 0.0001	< 0.0001
	2: Midwest	-0.333	0.027	< 0.0001
	3: South	-0.330	0.024	< 0.0001
	4: West (reference)	0.000	-	-
Complications
Acute liver failure	Yes (reference = No)	0.078	0.039	0.044	0.044
Acute respiratory Failure	Yes (reference = No)	0.204	0.036	< 0.0001	< 0.0001
Acute kidney injury	Yes (reference = No)	0.146	0.025	< 0.0001	< 0.0001
Hepatorenal syndrome	Yes (reference = No)	-0.132	0.050	0.008	0.009
IVC thrombosis	Yes (reference = No)	0.075	0.035	0.035	0.035
Acute blood loss anemia/ hemorrhagic	Yes (reference = No)	0.155	0.035	< 0.0001	< 0.0001
Cancer	Yes (reference = No)	-0.052	0.025	0.037	0.037
Elixhauser Comoridity Score excluding liver disease		0.005	0.001	< 0.0001	< 0.0001
Other variables
Number of procedures		0.118	0.004	< 0.0001	< 0.0001
Length of stay		0.054	0.001	< 0.0001	< 0.0001

IVC: Inferior vena cava.