SUNY Upstate Medical University Syracuse, New York
Introduction: Cirrhosis is the end-stage of chronic liver disease and is generally associated with poor outcome, increased hospitalizations, and mortality. The occurrence of decompensated cirrhosis further markedly increases mortality. Knowledge regarding the causes of mortality and hospitalization can help risk stratify hospitalized patients with cirrhosis.
Methods: Using the US Nationwide readmissions database 2014, we identified hospitalized patients who had cirrhosis and died during their hospitalization. In this cohort, we identified rates of cirrhotic and non-cirrhotic complications and etiologies for hospitalization. Causes of death were identified by the primary discharge diagnosis. Decompensated cirrhosis was defined as the presence of hepatic encephalopathy (HE), ascites, jaundice, variceal bleeding (VB), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), or hepatocellular carcinoma (HCC). Appropriate ICD-9 codes were used to identify all diagnoses and procedures.
Results: We studied 291,368 patients with cirrhosis of whom 38,394 patients (13.2%) died in-hospital. Around 19% of patients who had decompensation (53% of all patients) and 6.7% of patients who had compensated cirrhosis (47%) died during a hospitalization. Decompensated cirrhosis was present in 76.1% (N=29,212) of patients with mortality. Ascites was present in 50.3%, HE in 32.1%, VB in 23.2%, HRS in 19.4%, SBP in 9.1%, jaundice in 5.6% and HCC in 8.7%. In the overall cohort, the most common causes of death were sepsis (31.2%) followed by decompensated cirrhosis (13.6%), viral hepatitis (3.9%), respiratory failure (3.8%), and gastrointestinal bleeding (non-variceal) (3.8%). In patients with compensated cirrhosis, major causes of death were sepsis (33.8%), respiratory failure (6.3%), stroke (5.1%), congestive heart failure (3.4%), and traumatic intracranial injury (3.3%). When decompensation was present, major causes of death were sepsis (30.4%), decompensated cirrhosis (17.9%), gastrointestinal bleeding (4.6%), viral hepatitis (4.5%), and respiratory failure (3.1%).
Discussion: In the US, 1 in 7 hospitalized patients with cirrhosis, 1 in 5 with decompensated cirrhosis, and 1 in 14 with compensated cirrhosis had in-hospital mortality. Sepsis is the most common cause of death (1/3rd) in cirrhotic patients, in both compensated and decompensated cirrhosis. These data can help risk stratify and improve management strategies of hospitalized patients with cirrhosis.
