In-Hospital Outcomes of Patients with Acute Decompensated Heart Failure and Cirrhosis: An Analysis of the National Inpatient Sample

Abstract

Introduction Heart failure increases morbidity and mortality in patients admitted for cirrhosis. Our objective was to determine if patients with acute decompensated heart failure (ADHF) and cirrhosis would have increased mortality, hospital length of stay (LOS), and total hospital charges compared to patients with only ADHF. There is also a paucity of data regarding the influence of gender, race, ethnicity, insurance, and cirrhosis-related complications on mortality, hospital length of stay, and total hospitalization charges. In this study, we aim to identify risk factors in a national population cohort from 2016. Methods All patients above 18 years old with cirrhosis and ADHF admitted in 2016 were identified from the Nationwide Inpatient Sample (NIS). Multivariate regression analysis was used to estimate the odds ratio of in-hospital mortality, average length of stay (LOS), and total hospital charges after adjusting for the following factors: age, gender, race, Charlson and Elixhauser scores, primary insurance payer status, hospital type, hospital bed size, hospital region, and hospital teaching status. Statistical analysis was performed by using the survey procedures function in the statistical analysis system (SAS) software. Statistical significance was defined by the two-sided t-test with a p value < 0.05. Results The overall sample contained 363,050 patients. A total of 355,455 patients were admitted with ADHF and 2% of these patients had concomitant cirrhosis ( n = 7595) in 2016. The total mortality rate was 3.4%, hospital LOS was 6.6 days (with a median of 6.5 days), and the mean total hospital charge was $63,120.20. Patients with both ADHF and cirrhosis compared to patients without ADHF had increased mortality, hospital LOS, and cirrhosis-related complications. Conclusions As the incidence and prevalence of ADHF and cirrhosis increases worldwide, we urge the medical community to increase surveillance of patients with both diseases and perform rigorous cardiovascular risk assessments as well to improve patient outcomes.

Clinical outcomes in patients with heart failure with and without cirrhosis: an analysis from the national inpatient sample

“…The presence of underlying cirrhosis increases mortality risk in patients with HF. A recent analysis by Khalid et al [7] showed an in-patient mortality rate of 3.4% among HF hospitalized patients with cirrhosis. Cirrhosis leads to a chronic hyperdynamic circulatory state coupled with low systemic vascular resistance, and provides a backdrop for independent cardiomyopathy from the risk factors for the etiology of cirrhosis in itself (such as NASH/amyloid/hemochromatosis) [8].…”

Retrospective analyses of the outcomes among hospitalized liver cirrhosis patients with heart failure and COVID-19 infection: Insight from the National Inpatient Sample

“…Recent studies by Yazdanyar et al (2021) [19] and Khalid et al (2020) [20] which investigated the outcomes of hospitalized patients with HF and LC showed a similar 3.4 % in-hospital mortality rate in this population. Further, according to Ge et al (2021) [21] , the cumulative incidence of death at 30 days is 12.5 % among those patients with LC and HF with concurrent COVID-19 infection.…”

“…Moreover, previous studies suggested that COVID-19 infection increases the risk for the development of acute renal failure leading to circulatory volume overload which subsequently worsens cardiac dysfunction among those patients with pre-existing HF [17] , [18] . Although previous studies have shown that there is increased risk for morbidity and mortality among hospitalized LC with concurrent HF [19] , [20] , there is still paucity of data regarding the incremental risk of COVID-19 in this population. With this, we aim to investigate the in-hospital outcomes among hospitalized LC patients with comorbid HF and concurrent COVID-19 infection by utilizing a large nationwide database.…”

In-Hospital Outcomes of Patients With Pulmonary Hypertension and Cirrhosis: A 6-Year Population Cohort Study of Over One Million Patients

“…It is a difficult disease to understand and it is associated with a mortality at 5 years of 51% [ 9 ]. However, there is no current consensus on survival or prognostic factors for portopulmonary hypertension due to a scarcity of studies as well as a lack of data secondary to a small number of patients enrolled in clinical trials, a situation similar to that for patients with pulmonary hypertension and cirrhosis [ 10 ].…”

“…Cirrhosis, alone or in combination with pulmonary hypertension, is known to increase total hospital charges, but this disease decreases mortality and hospital LOS independently of other risk factors, likely due to improvements in management and the rise of palliative care [ 10 ]. However, this is not the same for patients with cirrhosis-related complications, as can be seen in our study as well.…”