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. 2022 Jul-Aug;35(4):427-433.
doi: 10.20524/aog.2022.0718. Epub 2022 May 12.

Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States

Hassam Ali  1 , Rahul Pamarthy  1 , Nicole Leigh Bolick  2 , Muhammad Fahd Farooq  3
Affiliations

Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States

Hassam Ali et al. Ann Gastroenterol. 2022 Jul-Aug.

Abstract

Background: Alcoholic hepatitis (AH) results in significant morbidity, mortality and healthcare burden. We aimed to evaluate the temporal trends of AH hospitalizations in the last decade and to devise a mortality scoring system for risk stratification.

Methods: National Inpatient Sample (NIS) databases from 2009-2019 were used to identify AH hospitalizations. Outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), mortality, and mortality predictors. A mortality scoring system was derived using multivariate Cox regression and validated using receiver operating characteristic curves.

Results: There was an increase in total AH hospitalizations, from 67,070 in 2009 to 125,540 in 2019 (P=0.004). The inpatient mortality increased from 2.48% in 2009 to 3.78% in 2019 (P=0.008). The MIC was $31,189 in 2009 and $62,229 in 2019 (P<0.001). A trend for LOS was not significant. Ten variables were selected for incorporation into a risk score, including anemia, age >60 years, female sex, mechanical ventilation, vasopressor use, spontaneous bacterial peritonitis, hepatorenal syndrome, acute renal failure, coagulopathy (thrombocytopenia), and hepatic encephalopathy. The score has a maximum of eight points, and the cutoff for predicting mortality was set as 4 points. The area under the curve (AUC) of the derivation cohort was 0.8766 (95% confidence interval [CI] 0.865-0.888) and AUC 0.862 (95%CI 0.855-0.868) for a 30-day period.

Conclusions: There has been an increase in AH hospitalizations and mortality in the last decade. The Tahira score provides an easy objective method to estimate inpatient 30-day mortality for AH hospitalizations.

Keywords: Alcoholic hepatitis; NIS; healthcare costs; mortality predictors; national inpatient sample.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Trends for alcoholic hepatitis hospitalizations and inpatient mortality for the study period (2009-2019)
Figure 2
Figure 2
Forest plot showing independent predictors of 30-day all-cause inpatient mortality for alcoholic hepatitis in the United States CI, confidence interval
Figure 3
Figure 3
Receiver operating curve (ROC) for the Tahira score in derivation and validation cohorts to predict inpatient 30-day mortality outcomes
See this image and copyright information in PMC

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