B0488 - Healthcare-Related Trends of Spontaneous Bacterial Peritonitis in Patients With Liver Disease - A National Inpatient Sample (NIS)-Based Study

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Pranav D. Patel, MD

Geisinger Medical Center
Danville, PA

Pranav D. Patel, MD¹, Deepa P. Budh, MD², Yash Shah, MD³, Deep Mehta, MD⁴, Sahil Raval, MD⁵, Pooja Shah, MBBS, MS⁶, Rutikbhai Desai, MBBS⁷, Benyam Addissie, MD⁸
¹Geisinger Medical Center, Danville, PA; ²St. Barnabas Health System, Bronx, NY; ³Hackensack Meridian Ocean Medical Center, Brick, NJ; ⁴St. Francis Medical Center, Trenton, NJ; ⁵Saint Peter's University Hospital, New Brunswick, NJ; ⁶Baroda Medical College, Brick, NJ; ⁷GMERS Medical College - Sola, Ahmedabad, Jersey City, NJ; ⁸Geisinger Health System, Danville, PA

Introduction: Spontaneous Bacterial Peritonitis (SBP) is an acute infection in patients with decompensated cirrhosis and ascites. It can lead to organ failures and death. and it is associated with a 20% in-hospital mortality rate. Although we know about some of the risk factors of SBP such as prior episodes of SBP, increasing age, and proton-pump inhibitors use, further updated characterization of patients withSBP is still needed to better understand trends and guide healthcare resource utilization. The aim of this study was to evaluate the most recent healthcare trends of SBP in patients with decompensated cirrhosis.

Methods: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2018 to 2019. We included alcoholic liver disease, hepatitis B and C, and NASH as causes of liver diseases using ICD-10-CM codes and subsequently divided them into SBP and non-SBP groups. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups of SBP and non-SBP cases. The co-morbidities were also studied along with demographic data.

Results: We included 324,111 patients with liver disease in the final analysis. Inpatient mortality of those with SBP (15%) was found to be significantly higher than those without SBP (2.4%) with a p-value of < 0.001. It was observed that males were more prone to have SBP (67%) as compared to females (33%). The age group of 48-67 tends to have SBP more than the other age groups (p-value < 0.001). The length of stay (~6 days) and cost of healthcare utilization for the SBP cases ($ 60,551) were higher as compared to the non- SBP cases ($ 38,870). 35% of patients with SBP were from lower household income groups of $1-24,999. Patients with Hepatitis C had higher inpatient admissions due to SBP as compared to other causes of Hepatitis (56% vs 48%, p-value < 0.001).

Discussion: Mortality is quite high in SBP patients when they develop sepsis. Appropriate initiation of antibiotics leads to better outcomes. Patients with Hepatitis C, those aged above 50 years, and lower socioeconomic status are associated with a higher incidence of SBP. Despite high mortality and increased healthcare utilization in patients diagnosed with SBP, the incidence of SBP is trending down given vigilance of diagnostic procedures and keeping a low threshold for diagnosing and prophylactically treating SBP in patients with liver cirrhosis.

		No SBP	SBP
Variable	N	N = 322,078	N = 2,033	p-value
Age in years at admission	3,24,111	57 (45, 65)	57 (51, 63)	< 0.001
DIED	3,23,903			< 0.001
1		7,715 (2.4%)	297 (15%)
Elective versus non-elective admission	3,23,767	40,853 (13%)	49 (2.4%)	< 0.001
FEMALE	3,24,091			< 0.001
Male		181,509 (56%)	1,354 (67%)
Female		140,549 (44%)	679 (33%)
HOSP_BEDSIZE	3,24,111			< 0.001
Small		64,263 (20%)	337 (17%)
Medium		92,330 (29%)	527 (26%)
Large		165,485 (51%)	1,169 (58%)
HOSP_LOCTEACH	3,24,111			< 0.001
Rural		20,125 (6.2%)	135 (6.6%)
Urban nonteaching		58,775 (18%)	290 (14%)
Urban Teaching		243,178 (76%)	1,608 (79%)
HOSP_REGION	3,24,111			< 0.001
North East		58,680 (18%)	307 (15%)
Mid West		64,370 (20%)	377 (19%)
South		120,563 (37%)	741 (36%)
West		78,465 (24%)	608 (30%)


Length of stay (cleaned) (days)	3,24,092	4.0 (2.0, 6.0)	6.0 (3.0, 10.0)	< 0.001
Insurance Type	3,23,669			< 0.001
Medicare		117,061 (36%)	696 (34%)
Medicaid		93,301 (29%)	736 (36%)
Private Insurance		77,709 (24%)	375 (19%)
Self Pay		21,712 (6.8%)	132 (6.5%)
No charge		1,989 (0.6%)	15 (0.7%)
Other		9,870 (3.1%)	73 (3.6%)
RACE	3,17,968			< 0.001
White		199,014 (63%)	1,172 (59%)
Black		46,106 (15%)	263 (13%)
Hispanic		47,465 (15%)	355 (18%)
Asian or Pacific Islander		9,571 (3.0%)	91 (4.6%)
Native American		4,136 (1.3%)	41 (2.1%)
Other		9,686 (3.1%)	68 (3.4%)
Total charges (cleaned)	3,22,775	38,870 (21,705, 72,187)	60,551 (32,871, 114,384)	< 0.001
YEAR	3,24,111			0.003
2018		157,447 (49%)	1,061 (52%)
2019		164,631 (51%)	972 (48%)
Median household income national quartile for patient ZIP Code	3,14,757			0.009
$1-24,999		105,207 (34%)	687 (35%)
$25,000-34,999		80,774 (26%)	552 (28%)
$35,000-44,999		72,759 (23%)	442 (22%)
45,000 or more		54,043 (17%)	293 (15%)
NASH	3,24,111			< 0.001
0		167,220 (52%)	1,659 (82%)
1		154,858 (48%)	354 (18%)
Hepatitis_B	3,24,111			< 0.001
0		305,217 (95%)	1,814 (89%)
1		16,861 (5.2%)	219 (11%)
Hepatitis_C	3,24,111			< 0.001
0		225,016 (70%)	887 (44%)
1		97,062 (30%)	1,146 (56%)
Alcoholic_Liver_Disease	3,24,111			0.2
0		257,242 (80%)	1,645 (81%)
1		64,836 (20%)	388 (19%)
Hepatitis	3,24,111	171,432 (53%)	1,679 (83%)	< 0.001
Liver_Disease	3,24,111	322,078 (100%)	2,033 (100%)
HTN	3,24,111			< 0.001
0		153,392 (48%)	1,131 (56%)
1		168,686 (52%)	902 (44%)
HLD	3,24,111			< 0.001
0		227,415 (71%)	1,782 (88%)
1		94,663 (29%)	251 (12%)
DM	3,24,111			< 0.001
0		263,576 (82%)	1,769 (87%)
1		58,502 (18%)	264 (13%)
Age_Group	3,24,111			< 0.001
18-27		11,777 (3.7%)	16 (0.8%)
28-37		34,722 (11%)	131 (6.4%)
38-47		47,089 (15%)	243 (12%)
48-57		79,578 (25%)	646 (32%)
58-67		90,120 (28%)	730 (36%)
68-77		42,903 (13%)	219 (11%)
78-87		13,369 (4.2%)	45 (2.2%)
88 and above		2,520 (0.8%)	3 (0.1%)

Table: Table 1. Trends of Spontaneous Bacterial Peritonitis (SBP).

Disclosures:

Pranav Patel indicated no relevant financial relationships.

Deepa Budh indicated no relevant financial relationships.

Yash Shah indicated no relevant financial relationships.

Deep Mehta indicated no relevant financial relationships.

Sahil Raval indicated no relevant financial relationships.

Pooja Shah indicated no relevant financial relationships.

Rutikbhai Desai indicated no relevant financial relationships.

Benyam Addissie indicated no relevant financial relationships.

Pranav D. Patel, MD¹, Deepa P. Budh, MD², Yash Shah, MD³, Deep Mehta, MD⁴, Sahil Raval, MD⁵, Pooja Shah, MBBS, MS⁶, Rutikbhai Desai, MBBS⁷, Benyam Addissie, MD⁸. B0488 - Healthcare-Related Trends of Spontaneous Bacterial Peritonitis in Patients With Liver Disease - A National Inpatient Sample (NIS)-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.