C0501 - Prevalence and Mortality of Hepatorenal Syndrome in Different Stages of CKD: A Retrospective National Inpatient Sample Database Study

Uchit Thapa, MBBS¹, Hira Hanif, MD², Anish Paudel, MD³, Harshith Thyagaturu, MD¹, Samir Jha, MD⁴, Lintha Shah, MBBS¹, Suravi Khanal, MBBS⁵, Parikshya Giri Rijal, MBBS¹, Navalok Sharma Ghimire, MBBS¹, Amna Shaukat, MBBS¹, Aashish K. Singh, MBBS⁶, Prakash Poudel Jaishi, MBBS⁷, Jasmine Shrestha, MBBS⁸, Asis Shrestha, MD^9
1Bassett Medical Center, Cooperstown, NY; ²Reading Tower Health, West Reading, PA; ³Reading Hospital Tower Health, West Reading, PA; ⁴Beth Israel Deaconess Medical Center, Boston, MA; ⁵Manipal College of Medical Sciences, Pokhara, Gandaki, Nepal; ⁶APPL, Nongpoh, Meghalaya, India; ⁷Al Kamil Health Center, Al Kamil, Janub ash Sharqiyah, Oman; ⁸Mercy Fort Smith, Fort Smith, AR; ⁹Rochester General Health, Rochester, NY

Introduction: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced cirrhosis with an 85% three-month mortality. However, the prevalence and mortality of HRS in relation to different stages of chronic kidney disease (CKD) are not well studied. Hence, we used the data from the 2019 National Inpatient Sample (NIS) database to compare the mortality in hospitalized patients with HRS across different stages of CKD.

Methods: We utilized the 2019 NIS database to identify all adult ( >18 years) patients with CKD (N18) and HRS (K76.7) using appropriate ICD-10-CM codes. We categorized chronic kidney disease into CKD I (GFR >=90 ml/min), CKD II (GFR=60-89 ml/min), CKD III (GFR=30-59 ml/min), CKD IV (GFR=15-29 ml/min) and CKD V (GFR < 15 ml/min) using the ICD codes N18.1, N18.2, N18.3, N18.4 and N18.5 respectively. A univariate screen followed by multivariate logistic regression was performed to adjust for potential hospital and patient level confounders. Stata 17.0 software was used to perform all statistical analyses.

Results: In 2019, there were a total of 46,555 cases of HRS. HRS was found to be more prevalent in males (61.3%) of the white race (67.67%). The total prevalence of patients with HRS was highest among the patients with CKD 3. However, on multivariate analysis, the odds of mortality was higher among patients with CKD stage 2 compared to the other CKD stages (OR 8.1, CI (4.9-13.2), P < 0.01).

Discussion: We would expect that the odds of mortality from HRS will increase as the CKD stage progresses. However, according to our study, patients with CKD stage 2 were found to have the highest odds of mortality with HRS compared to the other stages. This could be explained by patients with CKD stage 4 being on hemodialysis, which decreases pre-transplant mortality in HRS. The findings also suggest potential comorbidities confounding the higher mortality in patients with advanced-stage CKD. Some limitations of this study would include fewer patients in CKD stage 2, leading to a large confidence interval, thus requiring further evaluation with a possible prospective design.


Disclosures:


Uchit Thapa, MBBS¹, Hira Hanif, MD², Anish Paudel, MD³, Harshith Thyagaturu, MD¹, Samir Jha, MD⁴, Lintha Shah, MBBS¹, Suravi Khanal, MBBS⁵, Parikshya Giri Rijal, MBBS¹, Navalok Sharma Ghimire, MBBS¹, Amna Shaukat, MBBS¹, Aashish K. Singh, MBBS⁶, Prakash Poudel Jaishi, MBBS⁷, Jasmine Shrestha, MBBS⁸, Asis Shrestha, MD⁹. C0501 - Prevalence and Mortality of Hepatorenal Syndrome in Different Stages of CKD: A Retrospective National Inpatient Sample Database Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.