Nationwide increase in hospitalizations and hepatitis C among inpatients with cirrhosis and sequelae of portal hypertension

Abstract

Background & aims: Advanced liver disease and complications of portal hypertension are common indications for hospitalization. Our objectives were to characterize longitudinal trends in incidence, characteristics, and outcomes of patients hospitalized with complications of portal hypertension using a nationally representative data set.

Methods: Admissions for complications of portal hypertension (hepatic encephalopathy, ascites, or variceal bleed) were identified from the Nationwide Inpatient Sample between 1998 and 2003 using International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. International Classification of Diseases, 9th Revision, Clinical Modification procedural codes were used to identify liver transplantation and portosystemic shunt procedures. National estimates for incidence of hospitalization over time, in-hospital mortality, and hospital charges accounted for survey design.

Results: Hospitalization rates increased significantly by 5% annually between 1998 and 2003, particularly in the Northeast and the South. The prevalence of hepatitis C-related advanced liver disease among these hospitalized patients increased from 12.9% to 23.7%, and in those with HCV and concurrent alcohol-related disease the rate increased from 5.6% to 11.2%. US population-based in-hospital mortality increased modestly from 1.9 to 2.1 per 100,000 (P<.001), with hepatorenal syndrome as the strongest predictor of death (odds ratio, 9.5; 95% confidence interval, 8.4-10.7). The inflation-adjusted total economic burden of decompensated cirrhosis increased from $1.15 billion to $2.1 billion during the 6-year period (P<.003).

Conclusions: A significant increase in the incidence of hospitalization for complicated portal hypertension between 1998 and 2003 and a growing burden of hepatitis C-related disease have profound economic impact and underscore the need for interventions to prevent progression to advanced liver disease.