Introduction: Malnutrition is commonly found among hospitalized patients, and it is generally known to be associated with poor clinical outcomes. However, there is a lack of data on how outcomes of autoimmune hepatitis may differ in patients with malnutrition. Thus, we aim to assess the outcomes of autoimmune hepatitis in patients with malnutrition.
Methods: Adult patients hospitalized with autoimmune hepatitis from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2010-2014 were selected. Diagnoses were identified by using ICD-9 CM codes. Patient demographics and outcomes of autoimmune hepatitis were compared between the groups with and without malnutrition. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, cirrhosis, portal hypertension, hepatic encephalopathy, ascites, hepatorenal syndrome, varices/variceal bleeding, spontaneous bacterial peritonitis, and sepsis. Chi-squared tests and independent t-tests were used to compare proportions and means, respectively. Multivariate logistic regression analysis was performed to determine if malnutrition is an independent predictor of the outcomes, adjusting for age, sex, and race.
Results: Patients with malnutrition had longer length of stay (9.7 days vs. 5.3 days, p < 0.05) and higher total hospital charge ($95,283 vs. $47,239, p < 0.05). After adjusting for age, sex, and race, malnutrition was an independent risk factor for cirrhosis (adjusted odds ratio (aOR) 1.49, 95% confidence interval (CI): 1.34-1.64, p < 0.05), portal hypertension (aOR 1.79, 95% CI: 1.59-2.02, p < 0.05), hepatic encephalopathy (aOR 1.91, 95% CI: 1.69-2.16, p < 0.05), ascites (aOR 2.36, 95% CI: 2.11-2.63, p < 0.05), hepatorenal syndrome (aOR 3.67, 95% CI: 2.87-4.69, p < 0.05), varices/variceal bleeding (aOR 1.40, 95% CI: 1.22-1.61, p < 0.05), spontaneous bacterial peritonitis (aOR 1.49, 95% CI: 1.10-2.02, p < 0.05), sepsis (aOR 2.37, 95% CI: 2.06-2.73, p < 0.05), and inpatient mortality (aOR 2.52, 95% CI: 2.08-3.05, p < 0.05).
Discussion: Our study indicates that autoimmune hepatitis patients with malnutrition have worse outcomes, including increased odds of inpatient mortality, cirrhosis, portal hypertension, hepatic encephalopathy, ascites, hepatorenal syndrome, varices/variceal bleeding, spontaneous bacterial peritonitis, and sepsis. The results suggest that prompt recognition of nutritional status is warranted to improve the outcomes of autoimmune hepatitis.
