title: Esophageal variceal bleeding in hospitalized patients with cirrhosis.
abstract: Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerable mortality and morbidity. The aim of this study was to investigate the occurrence, impact, and trends of EVB in hospitalized cirrhotic patients on a nationwide level in the United States. We interrogated data from the Nationwide Inpatient Sample from 2002 to 2012. Utilizing International Classification of Diseases, Ninth Revision, Clinical Modification codes, we analyzed hospital discharges for cirrhosis and related EVB in adult patients. EVB in cirrhotic patients was independently associated with overall worse outcomes with respect to in-hospital mortality (10% vs 5%; P < 0.01) and hospital charges (median $41,000 vs $26,000; P < 0.01). In the period from 2002 to 2012, the number of cirrhosis-related hospitalizations increased from 337,956 to 570,220 (P < 0.01). Concurrently, the incidence of EVB in hospitalized cirrhotic patients declined from 8.60% to 5.78%, with an overall decreased trend (P < 0.01). The decline in the rate of EVB in hospitalized cirrhotic patients from 2002 to 2012 likely reflects the effectiveness of primary and secondary prophylaxis.
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Pant
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Madhav
authors.initials: M
authors.lastname: Desai
authors.affiliation: Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio.|Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilroy
mesh_terms: D000293:Adolescent; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult