Increasing Burden of Hepatic Encephalopathy Among Hospitalized Adults: An Analysis of the 2010–2014 National Inpatient Sample
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Hepatic encephalopathy (HE) is associated with substantial morbidity and mortality, contributing significant burden on healthcare systems.
We aim to evaluate trends in clinical and economic burden of HE among hospitalized adults in the USA.
Using the 2010–2014 National Inpatient Sample, we identified adults hospitalized with HE using ICD-9-CM codes. Annual trends in hospitalizations with HE, in-hospital mortality, and hospital charges were stratified by the presence of acute liver failure (ALF) or cirrhosis. Adjusted multivariable regression models were evaluated for predictors of in-hospital mortality and hospitalization charges.
Among 142,860 hospitalizations with HE (mean age 59.3 years, 57.8% male), 67.7% had cirrhosis and 3.9% ALF. From 2010 to 2014, total number of hospitalizations with HE increased by 24.4% (25,059 in 2010 to 31,182 in 2014, p < 0.001). Similar increases were seen when stratified by ALF (29.7% increase) and cirrhosis (29.7% increase). Overall in-hospital mortality decreased from 13.4% (2010) to 12.3% (2014) (p = 0.001), with similar decreases observed in ALF and cirrhosis. Total inpatient charges increased by 46.0% ($8.15 billion, 2010 to $11.9 billion, 2014). On multivariable analyses, ALF was associated with significantly higher odds of in-hospital mortality (OR 5.37; 95% CI 4.97–5.80; p < 0.001) as well as higher mean inpatient charges (122.6% higher; 95% CI + 115.0–130.3%; p < 0.001) compared to cirrhosis. The presence of ascites, hepatocellular carcinoma, and hepatorenal syndrome was associated with increased mortality.
The clinical and economic burden of hospitalizations with HE in the USA continues to rise. In 2014, estimated national economic burden of hospitalizations with HE reached $11.9 billion.
KeywordsHepatic encephalopathy Cirrhosis Acute liver failure Burden Mortality Charges Liver disease
Alcoholic liver disease
Acute liver failure
Hepatitis B virus
Healthcare Cost and Utilization Project
Hepatitis C virus
Nonalcoholic fatty liver disease
National (Nationwide) Inpatient Sample
GH and RJW were involved in study concept and design. GH and RJW were involved in acquisition of data. GH, EV, and RJW were involved in analysis and interpretation of data and statistical analysis. GH and RJW drafted the manuscript. GH, EV, RJW critically revised the manuscript for important intellectual content. RJW was involved in study supervision. RJW had full access to all the data in the study and took responsibility for the integrity of the data and accuracy of the data analysis.
Robert Wong is supported by an AASLD Foundation Clinical and Translational Research Award in Liver Diseases.
Compliance with ethical standards
Conflict of interest
RJW receives research funding from Gilead Sciences and Abbvie, has served as a consultant and member of the advisory board for Gilead Sciences, and serves on the speaker’s bureau for Gilead Sciences, Salix, and Bayer. RJW is also funded by an AASLD Foundational Clinical and Translational Research Award in Liver Diseases. GH receives funding from Gilead Sciences. EV reports no conflicts of interest.
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