Time trends in the health care burden and mortality of acute on chronic liver failure in the United States

Allen, Alina M.; Kim, Woojin; Moriarty, James P.; Shah, Nilay D.; Larson, Joseph J.; Kamath, Patrick S.

doi:10.1002/hep.28812

Cited by 151 publications

(124 citation statements)

References 20 publications

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“…Our previous study of all admissions for cirrhosis in the country, which used the National Inpatient Sample database, suggested that there were 659,000 admissions for cirrhosis in the United States in 2011 11. If we apply the admission rate of 100 per 100,000 population for initial hospitalization for cirrhosis in Olmsted County, the number of initial hospitalizations for cirrhosis in the United States for 2011 is estimated to have been 310,000.…”

Section: Discussionmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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Section: Discussionmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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“…The prevalence of cirrhosis is expected to steadily increase over the next decade and is likely to be driven by the rising prevalence of nonalcoholic fatty liver disease (NAFLD) and the downstream consequences of progressive liver disease due to nonalcoholic steatohepatitis (NASH) . The complications of cirrhosis have and will lead to more hospitalizations and acute‐on‐chronic liver failure (ACLF), which will increase the demand for liver transplantation (LT) . In addition, we expect to transplant older people with more chronic kidney disease (CKD) secondary to the decline in hepatitis B virus– and hepatitis C virus (HCV)–related advanced liver disease and a continued increase in the prevalence of NAFLD …”

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confidence: 99%

“…With an increased need for LT and the changes in the patient population listed for transplant, we expect more patients to need hospitalization before transplant . In addition, we anticipate ACLF will also continue to increase in incidence before LT. Current data have shown that transplant‐free survival is markedly reduced in patients who develop ACLF, regardless of the definition of ACLF used . This is also applicable to patients listed for LT who have a high mortality before LT once ACLF develops …”

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confidence: 99%

Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience

et al. 2019

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Acute‐on‐chronic liver failure (ACLF) characterized with ≥2 extrahepatic organ failures in cirrhosis carries a high mortality. Outcomes of patients listed for liver transplantation (LT) after ACLF and after LT are largely unknown. The North American Consortium for the Study of End‐Stage Liver Disease prospectively enrolled 2793 nonelectively hospitalized patients with cirrhosis; 768 were listed for LT. Within 3 months, 265 (35%) received a LT, 395 remained alive without LT, and 108 died/delisted. Compared with nonlisted patients, those listed were younger and more often had ACLF, acute kidney injury, and a higher admission Model for End‐Stage Liver Disease (MELD) score. ACLF was most common in patients who died/delisted, followed by those alive with and without LT respectively, (30%, 22%, and 7%, respectively; P < 0.001). At LT, median MELD was 27.9% and 70% were inpatients; median time from hospitalization to LT was 26 days. Post‐LT survival at 6 months was unchanged between those with and without ACLF (93% each at 6 months). There was no difference in 3‐ and 6‐month mean post‐LT creatinine in those with and without ACLF, despite those with ACLF having a higher mean pre‐LT creatinine and a higher rate of perioperative dialysis (61%). In conclusion, patients with and without ACLF had similar survival after transplant with excellent renal recovery in both groups.

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“…Liver failure remains a major challenge for physicians in liver centers and represents a marked health and economic burden in China and the United States [26,27]. The indications for artificial organ support and emergency liver transplantation in ACLF patients are poorly defined [28].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Age-Bilirubin-International Normalized Ratio-Creatinine Score in Short-Term Survival of Acute-on-Chronic Hepatitis B Liver Failure

Chen

Zheng

Cai

et al. 2018

Cell Physiol Biochem

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Background/Aims: The age-bilirubin-international normalized ratio-creatinine (ABIC) score, which is a predictive model commonly used for alcoholic hepatitis, has not yet been studied in acute-on-chronic hepatitis B liver failure (HBV-ACLF). We aimed to investigate the predictive value of the ABIC score in patients with HBV-ACLF. Methods: This retrospective study involved 398 patients diagnosed with HBV-ACLF, who were divided into a training cohort of 305 patients and a validation cohort of 93 patients. Univariate and multivariate Cox regression models were used to determine risk factors for mortality. Area under the receiver operating characteristic curve (AUC) was calculated to estimate and compare the predictive values of different prognostic scores. Results: The ABIC score was significantly higher in the death group of the training cohort than in its survival group. Independent risk factors for mortality identified by multivariate Cox analysis included blood urea nitrogen, ABIC score, and Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) score. For predicting 1- and 3-month mortality, AUC was higher for the ABIC score than for the Model for End-stage Liver Diseases (MELD) score (0.732 vs. 0.653, P < 0.05, 0.695 vs. 0.619, P < 0.05, respectively), CLIF-C OF score (0.693, P=0.353, 0.656, P=0.341, respectively), and Child-Pugh score (0.675, P=0.189, 0.656, P=0.300, Respectively). Patients with ABIC score > 9.44 had reduced 1- and 3-month survival rates. Conclusion: ABIC score is superior to MELD score in predicting short-term survival in HBV-ACLF patients. ABIC score > 9.44 predicts high short-term mortality risk in HBV-ACLF patients.

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Time trends in the health care burden and mortality of acute on chronic liver failure in the United States

Cited by 151 publications

References 20 publications

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience

Predictive Value of Age-Bilirubin-International Normalized Ratio-Creatinine Score in Short-Term Survival of Acute-on-Chronic Hepatitis B Liver Failure

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