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Severity, cost of hepatic encephalopathy increased; prevalence, mortality rate stable

The reported severity of symptoms and costs associated with hepatic encephalopathy increased during a 5-year period, while its incidence and inpatient mortality rate remained stable in a recent study.

Researchers analyzed data from the Nationwide Inpatient Sample during five cycles between 2005 and 2009. Evaluated factors included incidence and prevalence of hepatic encephalopathy (HE), symptom severity and inpatient mortality rates and resource utilization because of the condition.

Of 33.3 million recorded hospitalizations, 111,090 (0.33 ± 0.01%) were related to HE, with a stable prevalence rate between 2005 and 2009 (P=.2226). In-hospital mortality due to HE declined during the same period (15.61% to 14.37%; P=.0622).

Reported symptom severity increased between 2005 and 2009, (35.88% of patients reported extreme severity in 2005 compared with 43.12% in 2009; P<.0001), as did the average length of hospital stay (from 8.04 days to 8.53 days; P=.0191), the average number of procedures on record (1.91 to 2.24; P<.0001) and the average incurred charges per patient ($46,663 to $63,107 per case; P<.0001). Overall HE-related charges also increased consistently from 2005 ($4.67 billion) to 2009 ($7.24 billion).

Multivariate analysis indicated that “major or extreme” illness severity (OR=3.162, 2.835-3.528), fluid and electrolyte disorder comorbidities (OR=1.455, 1.392-1.522) and the number of procedures per discharge (OR=1.192, 1.177-1.208) and concomitant diagnoses (OR=1.022, 1.016-1.029) were independently predictive of inpatient mortality because of HE (95% CI for all). Predictors of greater costs and longer hospital stays included illness severity, number of procedures performed during admission, number of diagnoses upon discharge, use of Medicare and Medicaid and admission at a larger hospital in an urban area (P<.05 for all).

“The nationwide inpatient incidence of advanced liver disease is increasing, as is the prevalence of its feared complication of HE,” the researchers wrote. “Furthermore, the socioeconomic and financial burden of this disease consistently increases due to both the observed trend toward a more severe disease and higher treatment costs. Our findings confirm a strong necessity for the implementation of more effective public policy together with preventive care strategies and interventions that could reduce the incidence and delay the progression of chronic liver disease to advanced liver disease and its complications.”