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Comparison of inpatient outcomes in patients with Hepatitis B, Hepatitis C, and Hepatitis B and C co-infection with Cirrhosis

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Abstract

Background

Hepatitis B (HBV) and Hepatitis C (HCV) are among the most common causes of cirrhosis in the USA, with high mortality and morbidity but comparative outcomes were not well studied.

Methods

We retrospectively analyzed cirrhosis patients with HBV, HCV, and HBV/HCV coinfection from 2016 to 2019 in National Inpatient Sample (NIS) database. Our primary outcome was the length of stay (LOS), mean hospital charge and mortality.

Results

Our study included 701464 cirrhosis patients with HCV (89.7%), HBV (6.8%), and coinfection (3.5%) (P < 0.001). Male gender and white race were more common in all three cohorts (p < 0.001). The mean age for HBV, HCV, and coinfection was 55.59, 58.69, and 58.27 years. The mean LOS for HBV, HCV, and coinfection were 6.59 ± 0.1, 6.02 ± 0.03, and 6.74 ± 0.12 days respectively. The adjusted length of stay was 0.62 days longer in the HBV cohort and 0.61 days longer in the coinfection cohort, compared to the HCV cohort (P < 0.001). Adjusted hospital charges were $15112 higher in the HBV cohort and $ 6312 higher in the coinfection cohort, compared to the HCV cohort (P < 0.001). Patients with HBV had a higher risk of mortality compared to HCV infection (AOR 1.35, [1.22-1.48], P < 0.001); However, patients with coinfection had no difference in mortality compared to HCV infection.

Conclusion

Cirrhosis with HBV and coinfection is associated with increased duration of hospital stay and cost when compared to HCV infection. There is a higher risk of mortality in cirrhotic patients with HBV infection compared to HCV; however, no significant difference in mortality for coinfection compared to HCV.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Davis GL, Albright JE, Cook SF, Rosenberg DM (2003) Projecting future complications of chronic hepatitis C in the United States. Liver Transpl 9(4):331–8. https://doi.org/10.1053/jlts.2003.50073

    Article  PubMed  Google Scholar 

  2. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B (2010) Deaths: final data for 2007. Natl Vital Stat Rep 58(19):1–19

    PubMed  Google Scholar 

  3. Barazani Y, Hiatt JR, Tong MJ, Busuttil RW (2007) Chronic viral hepatitis and hepatocellular carcinoma. World J Surg 31(6):1243–8. https://doi.org/10.1007/s00268-007-9041-3

    Article  PubMed  Google Scholar 

  4. Lim JK, Nguyen MH, Kim WR et al (2020) Prevalence of Chronic Hepatitis B Virus Infection in the United States. Am J Gastroenterol 115(9):1429–1438. https://doi.org/10.14309/ajg.0000000000000651

  5. Rosenberg ES, Rosenthal EM, Hall EW et al (2018) Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016. JAMA Netw Open 1(8):e186371. https://doi.org/10.1001/jamanetworkopen.2018.6371

  6. Zhou K, Dodge JL, Grab J et al (2020) Mortality in adults with chronic hepatitis B infection in the United States: a population-based study. Aliment Pharmacol Ther 52(2):382–389. https://doi.org/10.1111/apt.15803

  7. Hall EW, Schillie S, Vaughan AS et al (2021) County-Level Variation in Hepatitis C Virus Mortality and Trends in the United States, 2005-2017. Hepatology 74(2):582–590. https://doi.org/10.1002/hep.31756

  8. Hirode G, Saab S, Wong RJ (2020) Trends in the Burden of Chronic Liver Disease Among Hospitalized US Adults. JAMA Netw Open 3(4):e201997. https://doi.org/10.1001/jamanetworkopen.2020.1997

  9. Cholankeril G, Perumpail RB, Hu M et al (2016) Chronic Hepatitis B Is Associated with Higher Inpatient Resource Utilization and Mortality Versus Chronic Hepatitis C. Dig Dis Sci 61(9):2505–15. https://doi.org/10.1007/s10620-016-4160-z

  10. Tyson GL, Kramer JR, Duan Z et al (2013) Prevalence and predictors of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients. Hepatology 58(2):538–45. https://doi.org/10.1002/hep.26400

    Article  PubMed  Google Scholar 

  11. Khera R, Angraal S, Couch T et al (2017) Adherence to Methodological Standards in Research Using the National Inpatient Sample. JAMA 318(20):2011–2018. https://doi.org/10.1001/jama.2017.17653

  12. Menendez ME, Neuhaus V, van Dijk CN, Ring D (2014) The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res. 472(9):2878–86. https://doi.org/10.1007/s11999-014-3686-7

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ali H, Pamarthy R, Bolick NL, Farooq MF (2022) Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States. Ann Gastroenterol 35(4):427–433. https://doi.org/10.20524/aog.2022.0718

  14. Waqar SHB, Ali H (2022) Changing incidence and survival of desmoplastic small round cell tumor in the USA. Proc (Bayl Univ Med Cent) 35(4):415–419. https://doi.org/10.1080/08998280.2022.2049581

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ali H, Pamarthy R, Bolick NL et al (2022) Relation between inflammatory bowel disease, depression, and inpatient outcomes in the United States. Proc (Bayl Univ Med Cent) 35(3):278–283. https://doi.org/10.1080/08998280.2022.2028344

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smith A, Baumgartner K, Bositis C (2019) Cirrhosis: Diagnosis and Management. Am Fam Physician 100(12):759–770

  17. Tsai JF, Chang WY, Jeng JE et al (1994) Hepatitis B and C virus infection as risk factors for liver cirrhosis and cirrhotic hepatocellular carcinoma: a case-control study. Liver. 14(2):98–102. https://doi.org/10.1111/j.1600-0676.1994.tb00055.x

    Article  CAS  PubMed  Google Scholar 

  18. Abdelaal R, Yanny B, El Kabany M (2019) HBV/HCV Coinfection in the Era of HCV-DAAs. Clin Liver Dis 23(3):463–472. https://doi.org/10.1016/j.cld.2019.04.003

  19. LaPar DJ, Stukenborg GJ, Guyer RA et al (2012) Primary payer status is associated with mortality and resource utilization for coronary artery bypass grafting. Circulation. 126(11 Suppl 1):S132–9. https://doi.org/10.1161/CIRCULATIONAHA.111.083782

    Article  PubMed  PubMed Central  Google Scholar 

  20. Halpern MT, Holden DJ (2012) Disparities in timeliness of care for U.S. Medicare patients diagnosed with cancer. Curr Oncol 19(6):e404–13. https://doi.org/10.3747/co.19.1073

  21. Levy V, Yuan J, Ruiz J et al (2010) Hepatitis B sero-prevalence and risk behaviors among immigrant men in a population-based household survey in low-income neighborhoods of northern California. J Immigr Minor Health 12(6):828–33. https://doi.org/10.1007/s10903-009-9239-6

    Article  PubMed  Google Scholar 

  22. Meillier A, Patel S, Al-Osaimi AM (2015) Readability of Healthcare Literature for Hepatitis B and C. Dig Dis Sci 60(12):3558–62. https://doi.org/10.1007/s10620-015-3808-4

    Article  PubMed  Google Scholar 

  23. Hyun S, Ko O, Kim S, Ventura WR (2021) Sociocultural barriers to hepatitis B health literacy in an immigrant population: a focus group study in Korean Americans. BMC Public Health 21(1):404. https://doi.org/10.1186/s12889-021-10441-4

  24. Lin YC, Chiu WN, Chang TS et al (2020) Liver Health Literacy and Health Status Among Adults With Hepatitis C: Implications for the Nursing Profession as Part of the 2030 Global Elimination Goal. J Nurs Scholarsh 52(2):128–135. https://doi.org/10.1111/jnu.12533

  25. Wang SS, Tsai YT, Lee SD et al (1991) Spontaneous bacterial peritonitis in patients with hepatitis B-related cirrhosis and hepatocellular carcinoma. Gastroenterology 101(6):1656–62. https://doi.org/10.1016/0016-5085(91)90405-a

    Article  CAS  PubMed  Google Scholar 

  26. Amin J, Law MG, Bartlett M et al (2006) Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study. Lancet 368(9539):938–45. https://doi.org/10.1016/S0140-6736(06)69374-4

    Article  PubMed  Google Scholar 

  27. Kim HS, Yang JD, El-Serag HB, Kanwal F (2019) Awareness of chronic viral hepatitis in the United States: An update from the National Health and Nutrition Examination Survey. J Viral Hepat 26(5):596–602. https://doi.org/10.1111/jvh.13060

  28. Essa M, Sabry A, Abdelsameea E et al (2019) Impact of new direct-acting antiviral drugs on hepatitis C virus-related decompensated liver cirrhosis. Eur J Gastroenterol Hepatol 31(1):53–58. https://doi.org/10.1097/MEG.0000000000001250

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Acknowledgement

I would like to thank my co-authors and institution for the support.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, East Carolina University, 521 Moye Blvd., 2nd floor, Greenville, NC, 27834, USA

    Rahul Pamarthy & Hassam Ali

  2. Department of Gastroenterology and Hepatology, Washington University, St. Louis, 63110, USA

    Devika Kapuria

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Contributions

Rahul Pamarthy: Conception and design; analysis and interpretation of the data; drafting of the article; final approval of the article. Hassam Ali: Critical revision of the article for important intellectual content; drafting of the article; final approval of the article. Devika Kapuria: Critical revision of the article for important intellectual content; drafting of the article; final approval of the article.

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Correspondence to Rahul Pamarthy.

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Pamarthy, R., Ali, H. & Kapuria, D. Comparison of inpatient outcomes in patients with Hepatitis B, Hepatitis C, and Hepatitis B and C co-infection with Cirrhosis. Ir J Med Sci 193, 157–163 (2024). https://doi.org/10.1007/s11845-023-03417-3

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