D0505 - Increasing Burden of Hepatorenal Syndrome and Acute Kidney Injury Among Hospitalized Patients With Chronic Liver Disease Is Associated With High In-Hospital Mortality and Increased Healthcare Resource Utilization

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Robert Wong, MD, MD, FACG

Stanford University School of Medicine/Veterans Affairs Palo Alto Healthcare System
Palo Alto, CA

Robert Wong, MD, MD, FACG¹, Jeyasankar Balasubramanian, BS², Khurram Jamil, MD³, Xingyue Huang, PhD²
¹Stanford University School of Medicine/Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA; ²Mallinckrodt Pharmaceuticals, Hampton, NJ; ³Mallinckrodt, Hampton, NJ

Introduction: Hepatorenal syndrome (HRS) is a severe form of acute kidney injury (AKI) that develops in patients with decompensated liver disease and is associated with high morbidity and mortality. Understanding epidemiologic trends in HRS and AKI among chronic liver disease (CLD) patients will provide valuable data to guide healthcare resource planning. We aimed to evaluate trends in hospitalized patients with CLD and HRS or AKI in the US and the impact on in-hospital mortality and healthcare resource utilization (HCRU).

Methods: Hospitalized patients with CLD (including cirrhosis) between 2016 and 2021 were identified using the Premier Healthcare Database, a comprehensive electronic healthcare database that captures data from over 1,041 hospitals/healthcare systems in the US. Among hospitalized CLD patients, annual incidence rates for patients with HRS or AKI (based on ICD-10 codes) were evaluated. Trends in in-hospital mortality and HCRU (hospital length of stay (LOS), total hospitalization charges) were evaluated for CLD patients with HRS or AKI.

Results: A total of 3,580,434 hospitalizations with CLD were identified, representing approximately 6.7% of all hospitalizations during the study period. The proportion of CLD hospitalizations increased from 5.8% in 2016 to 7.7% in 2021. Among hospitalized CLD patients, the proportion with HRS increased from 1.9% in 2016 to 2.4% in 2021 (p< 0.01), and the proportion with AKI increased from 25.4% in 2016 to 31.3% in 2021 (p< 0.01). Hospitalized CLD patients with HRS or AKI had significant co-morbidities (ascites: 76% (HRS), 25% (AKI); alcohol-related diseases: 58% (HRS), 28% (AKI); diabetes: 36% (HRS), 44% (AKI)). From 2016 to 2021, while mean hospital LOS for CLD patients with HRS or AKI remained stable, mean total hospitalization charges significantly increased from $111,605 to $154,316 in CLD patients with HRS, and from $106,194 to $155,314 in CLD patients with AKI. Compared to overall CLD patients, significantly higher in-hospital mortality was observed in CLD patients with HRS (26.3% vs. 7.0%, p< 0.01) and in CLD patients with AKI (18.3% vs. 7.0%, p< 0.01).

Discussion: The burden of CLD hospitalizations in the US continues to rise. The increasing burden of hospitalized CLD patients with HRS or AKI is particularly concerning, given that these patients have significantly greater co-morbidities, high HCRU, and high mortality, emphasizing the clinical and economic burden of HRS and AKI among CLD patients in the US.

	2016	2017	2018	2019	2020	2021	Total
All CLD admissions N	529,556	597,346	616,434	637,599	591,654	607,845	3,580,434
Patients with HRS N [%]	9,838 [1.9%]	10,955 [1.8%]	11,388 [1.8%]	12,610 [2.0%]	13,513 [2.3%]	14,371 [2.4%]	72675 [2.0%]
Age mean [median]	59.4 [60.0]	59.5 [60.0]	59.6 [60.0]	59.4 [60.0]	58.5 [59.0]	58.1 [59.0]	59.0 [60.0]
Sex female n [%]	3,795 [38.6%]	4,262 [38.9%]	4,429 [38.9%]	4,971 [39.4%]	5,285 [39.1%]	5,577 [38.8%]	28,319 [39.0%]
Ascites n [%]	7,098 [72.1%]	8,140 [74.3%]	8,600 [75.5%]	9,564 [75.8%]	10,442 [77.3%]	11,231 [78.2%]	55,075 [75.8%]
Sepsis n [%]	2,884 [29.3%]	3,360 [30.7%]	3,430 [30.1%]	3,822 [30.3%]	4,317 [31.9%]	4,642 [32.3%]	22,455 [30.9%]
Alcohol n [%]	5,305 [53.9%]	6,032 [55.1%]	6,300 [55.3%]	7,169 [56.9%]	8,195 [60.6%]	8,880 [61.8%]	41,881 [57.6%]
Diabetes n [%]	3,482 [35.4%]	3,994 [36.5%]	4,082 [35.8%]	4,604 [36.5%]	4,600 [34.0%]	4,896 [34.1%]	25,658 [35.3%]
Covid19 n [%]	0 [0.0%]	0 [0.0%]	0 [0.0%]	0 [0.0%]	329 [2.4%]	560 [3.9%]	889 [1.2%]
Medicare Coverage n [%]	4,388 [44.6%]	4,904 [44.8%]	5,061 [44.4%]	5,685 [45.1%]	5,570 [41.2%]	5,608 [39.0%]	31,216 [43.0%]
Length of stay mean [median]	10.2 [7.0]	10.2 [7.0]	10.0 [7.0]	10.3 [7.0]	10.4 [7.0]	10.6 [7.0]	10.3 [7.0]
Total charges mean [median]	$111,665 [$60,802]	$123,493 [$66,826]	$131,775 [$69,044]	$142,023 [$75,711]	$152,298 [$79,024]	$154,316 [$82,604]	$137,856 [$72,860]
In-hospital mortality n [%]	2,703 [27.5%]	3,007 [27.4%]	3,013 [26.5%]	3,176 [25.2%]	3,414 [25.3%]	3,773 [26.3%]	19,086 [26.3%]
Patients with AKI N [%]	134,291 [25.4%]	156,666 [26.2%]	166,400 [27.0%]	178,618 [28.0%]	179,355 [30.3%]	189,957 [31.3%]	1,005,287 [28.1%]
Age mean [median]	61.9 [62.0]	62.1 [63.0]	62.2 [63.0]	62.4 [64.0]	62.1 [63.0]	62.2 [64.0]	62.2 [63.0]
Sex female n [%]	54,088 [40.3%]	63,665 [40.6%]	67,235 [40.4%]	71,977 [40.3%]	71,603 [39.9%]	76,903 [40.5%]	405,471 [40.3%]
Ascites n [%]	31,671 [23.6%]	37,642 [24.0%]	40,716 [24.5%]	44,254 [24.8%]	44,187 [24.6%]	47,476 [25.0%]	245,946 [24.5%]
Sepsis n [%]	42,958 [32.0%]	51,240 [32.7%]	55,004 [33.1%]	58,197 [32.6%]	63,730 [35.5%]	68,420 [36.0%]	339,549 [33.8%]
Alcohol n [%]	36,854 [27.4%]	42,619 [27.2%]	45,380 [27.3%]	48,696 [27.3%]	50,633 [28.2%]	53,584 [28.2%]	277,766 [27.6%]
Diabetes n [%]	56,749 [42.3%]	67,130 [42.8%]	73,140 [44.0%]	78,728 [44.1%]	79,554 [44.4%]	84,586 [44.5%]	439,887 [43.8%]
Covid19 n [%]	0 [0.0%]	0 [0.0%]	0 [0.0%]	0 [0.0%]	11,866 [6.6%]	19,341 [10.2%]	31,207 [3.1%]
Medicare Coverage n [%]	71,777 [53.4%]	85,441 [54.5%]	91,050 [54.7%]	98,562 [55.2%]	96,162 [53.6%]	100,518 [52.9%]	543,510 [54.1%]
Length of stay mean [median]	9.3 [6.0]	9.3 [6.0]	9.3 [6.0]	9.3 [6.0]	9.7 [6.0]	10.3 [6.0]	9.6 [6.0]
Total charges mean [median]	$106,194 [$54,538]	$114,993 [$58,751]	$122,257 [$61,372]	$131,239 [$64,916]	$141,955 [$69,822]	$155,314 [$75,501]	$130,336 [$64,553]
In-hospital mortality n [%]	23,307 [17.4%]	27,602 [17.6%]	28,796 [17.3%]	29,893 [16.7%]	34,368 [19.2%]	39,546 [20.8%]	183,512 [18.3%]

Table: Table 1. Patient demographics, clinical characteristics, resource use, total charges, and in-hospital mortality.
Footnote: HRS: Hepatorenal syndrome, AKI: Acute kidney injury.

Disclosures:

Robert Wong: Gilead Sciences – Consultant, Grant/Research Support.

Jeyasankar Balasubramanian: Mallinckrodt Pharmaceuticals – Employee.

Khurram Jamil: Mallinckrodt – Employee.

Xingyue Huang: Mallinckrodt Pharmaceuticals – Employee.

Robert Wong, MD, MD, FACG¹, Jeyasankar Balasubramanian, BS², Khurram Jamil, MD³, Xingyue Huang, PhD². D0505 - Increasing Burden of Hepatorenal Syndrome and Acute Kidney Injury Among Hospitalized Patients With Chronic Liver Disease Is Associated With High In-Hospital Mortality and Increased Healthcare Resource Utilization, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.