title: Hepatorenal syndrome in hospitalized patients with chronic liver disease: results from the Nationwide Inpatient Sample 2002-2012.
abstract: Hepatorenal syndrome (HRS) is one of the leading causes of hospitalizations in patients with chronic liver disease (CLD). We conducted a retrospective national database study to determine the epidemiology of HRS in hospitalized patients with CLD. Data from a Nationwide Inpatient Sample were extracted from 2002 to 2012 using ICD-9-CM codes related to CLD and HRS. The following outcomes were examined: in-hospital mortality, total charges, length of stay (LOS), patient demographics, procedures, complications, and comorbidities. Statistical analysis including regression was performed to examine factors associated with HRS. During 2002-2012, hospital discharges related to CLD increased from 407,246 to 836,475 with an increase of 37.9% for HRS as a complication in this population. Patients with CLD and HRS had worse outcomes compared with patients with CLD without HRS. This was manifested as a higher mortality rate (32.0% vs 10.3%), increased LOS (median 7 vs 5 days), and increased hospital costs (median $16,000 vs $11,000). Logistic regression demonstrated that HIV/AIDS (adjusted OR 2.9, 95% CI 2.2 to 3.9), pneumonia (aOR 2.8, 95% CI 2.3 to 3.2), and esophageal variceal bleeding (aOR 1.9, 95% CI 1.7 to 2.0) were associated with higher mortality in patients with HRS. Conversely, liver transplantation (aOR 0.1, 95% CI 0.1 to 0.1), transjugular intrahepatic portosystemic shunt (aOR 0.5, 95% CI 0.4 to 0.6), and hospitalization in the Midwest region of the USA (aOR 0.7, 95% CI 0.6 to 0.7) were associated with reduced mortality. The incidence of HRS in hospitalized patients with CLD increased during 2002-2012. HRS is associated with significant mortality and morbidity in these patients.
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: C
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, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Jani
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: M
authors.initials: M
authors.lastname: Desai
authors.affiliation: Medicine Institute Center for Value Based Care, Cleveland Clinic, Cleveland, Ohio, USA Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: A
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, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Pandya
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
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, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gilroy
authors.affiliation: Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: M
authors.initials: M
authors.lastname: Olyaee
mesh_terms: D002908:Chronic Disease; D005260:Female; D006530:Hepatorenal Syndrome / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis
keywords: Ant-CCP; Autoantibodies; Fibromyalgis/Pain Syndromes; Rheumatoid Arthritis