Ashwani K Singal1, Zunirah Ahmed2, Page Axley3, Sumant Arora4, Juan P Arab5, Allen Haas6, Yong-Fang Kuo6, Patrick S Kamath7. 1. Division of Gastroenterology and Hepatology, Department of Medicine, Transplant Hepatologist and Chief Clinical Research Affairs, Avera McKennan University Hospital Transplant Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, 57105, USA. ashwanisingal.com@gmail.com. 2. Department of Internal Medicine, University of Alabama at Birmingham, Montgomery, AL, USA. 3. Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. 4. Division of Gastroenterology, Department of Medicine, University of Iowa Hospital & Clinics, Iowa, USA. 5. Department of Gastroenterology and Hepatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 6. Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA. 7. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Abstract
BACKGROUND AND AIM: Acute on chronic liver failure (ACLF) in patients with cirrhosis has high short-term mortality. Data comparing ACLF admissions to academic centers (AC) and non-academic centers (NAC) are scanty. METHODS: National Inpatient Sample (2006-2014) was queried for admissions with cirrhosis and ACLF using the ICD-09 codes, and was stratified to AC or NAC. RESULTS: Of 1,928,764 admissions with cirrhosis (2006-2014), 112,174 (5. 9%) had ACLF. 6.7% of 1,018,568 cirrhosis admissions to AC had ACLF versus 5% of 910,196 admissions to NAC, P < 0.0001. Proportion of ACLF admissions to AC increased from 49% during 2006-2008 to 59% during 2012-2014. In a cohort of 73,630 ACLF admissions (36,615 each to AC and NAC) matched for patient demographics, cirrhosis etiology, number of comorbidities, elective versus emergent admission, ACLF grade, and type of organ failure. In-hospital mortality declined by 7% over the study period, but remained higher in AC (46% vs. 42%, P < 0.001), with 11% increased odds for in-hospital mortality compared to admission to NAC. Further admissions to AC versus NAC had higher median (IQR) length of stay at 13 (6-25) versus 11 (5-20) days, with higher median (IQR) hospital charges: 138,239 (66,772-275,603) versus 116,209 (55,767-232,699) USD, P < 0.001 for both. CONCLUSION: Patients with ACLF have high in-hospital mortality. Further, this is higher among admissions to AC. Although the in-hospital mortality is improving, strategies are needed on early identification of patients with futility of care for early discussion on goals of care, and optimal utilization of hospital resources among admissions with ACLF.
BACKGROUND AND AIM: Acute on chronic liver failure (ACLF) in patients with cirrhosis has high short-term mortality. Data comparing ACLF admissions to academic centers (AC) and non-academic centers (NAC) are scanty. METHODS: National Inpatient Sample (2006-2014) was queried for admissions with cirrhosis and ACLF using the ICD-09 codes, and was stratified to AC or NAC. RESULTS: Of 1,928,764 admissions with cirrhosis (2006-2014), 112,174 (5. 9%) had ACLF. 6.7% of 1,018,568 cirrhosis admissions to AC had ACLF versus 5% of 910,196 admissions to NAC, P < 0.0001. Proportion of ACLF admissions to AC increased from 49% during 2006-2008 to 59% during 2012-2014. In a cohort of 73,630 ACLF admissions (36,615 each to AC and NAC) matched for patient demographics, cirrhosis etiology, number of comorbidities, elective versus emergent admission, ACLF grade, and type of organ failure. In-hospital mortality declined by 7% over the study period, but remained higher in AC (46% vs. 42%, P < 0.001), with 11% increased odds for in-hospital mortality compared to admission to NAC. Further admissions to AC versus NAC had higher median (IQR) length of stay at 13 (6-25) versus 11 (5-20) days, with higher median (IQR) hospital charges: 138,239 (66,772-275,603) versus 116,209 (55,767-232,699) USD, P < 0.001 for both. CONCLUSION:Patients with ACLF have high in-hospital mortality. Further, this is higher among admissions to AC. Although the in-hospital mortality is improving, strategies are needed on early identification of patients with futility of care for early discussion on goals of care, and optimal utilization of hospital resources among admissions with ACLF.
Entities:
Keywords:
ACLF; Admissions; Cirrhosis; Health care burden; Resources
Authors: Muhammad Waleed; Mohamed A Abdallah; Yong-Fang Kuo; Juan P Arab; Robert Wong; Ashwani K Singal Journal: Front Physiol Date: 2020-12-03 Impact factor: 4.566
Authors: César Jiménez; Meritxell Ventura-Cots; Margarita Sala; Margalida Calafat; Montserrat Garcia-Retortillo; Isabel Cirera; Nuria Cañete; Germán Soriano; María Poca; Macarena Simón-Talero; José Altamirano; Michael Lucey; Guadalupe Garcia-Tsao; Robert S Brown; Robert F Schwabe; Elizabeth C Verna; Bernd Schnabl; Francisco Bosques-Padilla; Philippe Mathurin; Juan Caballería; Alexandre Louvet; Debbie L Shawcross; Juan G Abraldes; Joan Genescà; Ramon Bataller; Víctor Vargas Journal: Liver Int Date: 2022-03-07 Impact factor: 8.754