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Inpatient mortality decreases over time among patients with cirrhosis

In a large cohort of hospitalized patients with cirrhosis, researchers found that inpatient survival improved between 2002 and 2010, according to newly published data.

Researchers, including Paul H. Hayashi, MD, MPH, division of gastroenterology and hepatology, University of North Carolina, analyzed data of 781,515 hospitalized patients with cirrhosis between 2002 and 2010 using the Healthcare Cost and Utilization Project’s National Inpatient Sample. The researchers compared data with those from equal numbers of hospitalizations of patients without cirrhosis and patients with congestive heart failure (CHF). The primary outcome was a change in discharge status over time, according to the research.

Paul H. Hayashi

“Our goal was to see if inpatient mortality of cirrhotic patients has improved over time and to evaluate clinical variables associated with mortality including specific cirrhosis-related diagnoses and interventions,” the researchers wrote.

The mortality rate of patients with and without cirrhosis and patients with CHF decreased by (41% vs. 19% vs. 44%, respectively) over time, according to the analysis. Patients with cirrhosis experienced a greater decrease (9.1% to 5.4%) compared with patients without cirrhosis (2.6% to 2.1%) and patients with CHF (2.5% to 1.4%; P < .01). The independent mortality risk ratio decreased to 0.5 by 2010 regardless of the increasing age and comorbidities.

The relative decreases among patients with cirrhosis were similar to those of patients with CHF (41% vs. 44%, respectively).

Factors associated with a high mortality rate included hepatorenal syndrome, hepatocellular carcinoma, variceal bleeding and spontaneous bacterial peritonitis. However, the independent mortality risks for each decreased steadily, the researchers wrote. Sepsis was associated with increased mortality and this risk increased over time.

“The improving inpatient survival despite aging and more medically complex cirrhotic patients is remarkably consistent across several cirrhosis complications and suggests improving cirrhosis care that may extend beyond general improvements in inpatient care,” the researchers wrote. “As cirrhosis-related admissions continue to increase and hospitals increasingly are held accountable for outcomes, our data may help in setting appropriate quality care indicators, including guideline use, adjusted mortality risk and use of palliative care.”

In an editorial, Fasiha Kanwal, MD, MSHS, of Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, stated the findings by Schmidt and colleagues were “remarkable” and not completely unexpected.

Fasiha Kanwal

“This study provides one of the first data on the trends in overall in-hospital mortality among a large group of cirrhosis patients who were treated in U.S. hospitals,” Kanwal said. “The substantial improvement in survival is encouraging for patients and their clinicians.”

Kanwal further stated: “The study highlights the need for systematic efforts targeted at reducing cirrhosis-related in-hospital mortality while reaffirming the subgroup that need them the most because of their high risk of short-term complications.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.