Introduction: The healthcare cost and utilization project has classified hospitals as small, medium, and large bed size. This division is based on the hospital's region, location, and teaching status. To our knowledge, there have been no studies assessing the impact of bed size on the development of acute on chronic liver failure (ACLF) in patients with decompensated cirrhosis. We hypothesize that large bed size hospitals care for a sicker population and admitted patients have a higher incidence and risk of developing ACLF.
Methods: We queried the National Inpatient Sample (NIS) database using ICD-10 codes. ACLF was defined as the presence of renal failure or hepatic encephalopathy and one other organ dysfunction or two non-renal organ failures in patients with cirrhosis and a decompensating event. Decompensating events were defined as presence of ascites, varices, hepatic encephalopathy, or infection. The relationship between hospital bed size and ACLF in patients with decompensated cirrhosis was examined using multivariate analysis.
Results: A total of 1.78 million adult patients were admitted with a diagnosis of acute decompensation of cirrhosis. Of these, 945,440 (52.8%) were admitted to large bed size hospitals. Patients admitted to large bed size hospitals had a higher incidence of hepatic encephalopathy, ascites, and variceal bleeding. Patient demographics are presented in Table 1. Of the total patients admitted with a decompensating event, 830,365 patients (46.4%) met criteria for ACLF. A total of 453,095 patients (54.6%) who developed ACLF were admitted to large bed size hospitals. Our study found that patients admitted to large bed size hospitals have 20% higher odds of developing ACLF (aOR-1.20, 95% CI-1.17-1.23, p< 0.001). Large bed size hospitals were also associated with a higher risk of developing ACLF grades 2 and 3 (aOR-1.27, 95% CI-1.24-1.32, p< 0.001 and aOR-1.73, 95% CI-1.51-1.98, p< 0.001, respectively).
Discussion: Our study identifies hospital bed size as a significant predictor for development of ACLF in patients admitted with decompensated cirrhosis. Targeted education and implementation of best practices focused on large hospitals may help reduce the risk of ACLF.
