Objectives: The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods: We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results: A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion: Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.

Background and Aims Esophageal variceal bleeding is a common reason for hospitalization in patients with cirrhosis. The main objective of this study was to analyze the effects of gender differences on outcomes in hospitalizations related to Esophageal variceal bleeding in the United States. Methods A retrospective observational cohort study was performed using the National Inpatient Sample (NIS) database for all hospitalizations with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The primary outcome was in-hospital mortality, while secondary outcomes included rate of early endoscopy (defined as less than 1 day), AKI, blood transfusion, sepsis, ICU admission and TIPS (Transjugular Intrahepatic Portosystemic Shunt). We also compared the length of stay and total hospitalization charges. Results We identified a total of 166,760 patients with variceal bleeding of which 32.7% were females. In-hospital mortality was higher in males, 9.91%, compared to females, 8.31% (adjusted odds ratio (aOR): 0.88, p-value=.008, when adjusted for confounding factors). The odds of undergoing an EGD, length of stay, or total hospitalization charges did not differ between the two groups. Compared to men, women had lower odds of receiving TIPS (aOR = 0.83, p-value=.002). Conclusion Women hospitalised with esophageal variceal bleeding are at a lower risk of death compared to males. Further research is needed to elucidate the factors associated with this lower risk.

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Background Chronic pancreatitis (CP) is a pathological fibroinflammatory response to persistent inflammation or stress to the pancreas. The effect of frailty on outcomes in patients with CP has not been previously examined. In this study, we examined the effect of frailty on outcomes in hospitalized patients with CP. Methods Records of patients with a primary or secondary discharge diagnosis of CP (ICD10-CM codes K86.0, K86.1) between January 2016 and December 2019 were obtained from the National Inpatient Sample database. Data were collected on patient demographics, hospital characteristics, comorbidities, and etiology of CP. The relationship between frailty and outcomes, including mortality, intensive care unit (ICU) admission, sepsis, shock, length of stay (LOS), and total hospitalization charges (THC), were analyzed using multivariate analysis. Results 722,160 patients were included in the analysis. Patients with a high hospital frailty risk score had a higher mortality risk (adjusted odds ratio [aOR] 12.57, 95% confidence interval [CI] 10.42-15.16; P<0.001) compared to patients with low frailty scores. Patients with high frailty scores also had a higher risk of sepsis (aOR 5.75, 95%CI 4.97-6.66; P<0.001), shock (aOR- 26.25, 95%CI-22.83-30.19; P<0.001), ICU admission (aOR 25.86, 95% CI-22.58-29.62; P<0.001), and acute kidney injury (aOR 24.4, 95%CI 22.39-26.66; P<0.001). They also had a longer LOS (7.04 days, 95%CI 6.57-7.52; P<0.001) and higher THC ($72,200, 95%CI 65,904.52-78,496.66; P<0.001). Conclusions Frail patients, as determined by their hospital frailty risk score, are at high risk of worse outcomes. This data suggests opportunities for physicians to risk-stratify patients and predict outcomes.

Introduction: Palliative care is a service with a very wide vision and potent tool. Palliative care applies early in the course of terminal illness in conjunction with therapies intended to prolong life; it is not limited to end-of-life care. Patients with liver cirrhosis only have one healing treatment, a liver transplant, but the limitation in the number of donor organs and eligibility criteria reduces the number of transplants. The MELD-Na score provides validated mortality prognostic for the next 90 days in patients with liver cirrhosis. This study aimed to determine if palliative care services are underutilized and could be more evident in uninsured or undocumented patients. Methods: Objective: Describe the use of Palliative Care service in patients with liver cirrhosis stratified by MELD Na score. Data retrieved from Valley Baptist Medical Center in Harlingen Cerner included all patients 18 years or older with diagnoses of fibrosis or liver cirrhosis on admission or made during the hospital stay from January 2015 to December 2019. The total number of patients was 150. Results: Distribution by sex, male 83 (55.33%), female 67 (44.67%). The mean age was 63.07 years. Predominant etiology of cirrhosis was alcoholism 64(42.67%), NASH 11 (7.33%), Viral 5 (3.33%), Other 15 (10%), and unknown 55 (36.67%). With legal status 140 patients (93.33%), and without 10 patients (6.67%). Patients with insurance 131 (87.33%) and without 19 (12.67%). Patients underwent palliative care services 16 (10.67%). A total of 50 (33.33%) patients underwent EGD. A total of 31 (20.6%) patients underwent paracentesis. (Figure ) Conclusion: Our result showed that the number of patients with palliative care consultations was under the expected percentage. In an external study, of 59,687 hospitalized adults with terminal decompensated cirrhosis, 29.1% received palliative care. In multiple studies, palliative care was associated with a lower procedure burden after adjusting for other factors; it was associated with a cost reduction of $8892. In our study, the cost was not evaluated, but it is expected that the patient with palliative care consults will reduce hospitalization costs. Most of the patients had insurance and legal status. The dispersion of the MELD-Na score was similar in patients with and without palliative care consultations. Our patients had a high number of EGD and paracentesis for ascites. (Table )