Decreasing Mortality Among Patients Hospitalized with Cirrhosis in the United States From 2002 through 2010.
Gastroenterology. 2015 Jan 23;
Authors: Schmidt M, Barritt AS, Orman ES, Hayashi PH
BACKGROUND & AIMS: It is not clear whether evidence-based recommendations for inpatient care of cirrhosis patients are widely implemented or are effective in the community. We investigated changes in inpatient outcomes and associated features over time.
METHODS: Using the Healthcare Cost and Utilization Project, National Inpatient Sample, we analyzed 781,515 hospitalizations of patients with cirrhosis from 2002 through 2010. We compared data with those from equal numbers of hospitalizations of patients without cirrhosis and patients with congestive heart failure (CHF), matched for age, sex, and year of discharge. Primary outcome was change in discharge status over time. Factors associated with outcomes were analyzed by Poisson modeling.
RESULTS: Mortality of patients with and without cirrhosis, and patients with CHF, decreased over time. The absolute decrease was significantly greater for patients with cirrhosis (from 9.1% to 5.4%) than those without cirrhosis (from 2.6% to 2.1%) or those with CHF (from 2.5% to 1.4%) (P<.01), However, relative decreases were similar for patients with cirrhosis (41%) and patients with CHF (44%). For patients with cirrhosis, the independent mortality risk ratio decreased steadily to 0.50 by 2010 (95% confidence interval, 0.48-0.52), despite their increasing age and comorbidities. Hepatorenal syndrome, hepatocellular carcinoma, variceal bleeding, and spontaneous bacterial peritonitis were associated with higher mortality, but the independent mortality risks for each decreased steadily. Sepsis was strongly associated with increased mortality, and risk increased over time.
CONCLUSIONS: Among patients with cirrhosis in the US, inpatient mortality decreased steadily from 2002 through 2010, despite increases in patient age and medical complexity. Improvements in cirrhosis care may have contributed to increases in patient survival, beyond those attributable to general improvements in inpatient care. Further improvements might require increased use of proven therapies and development of new treatments-particularly for sepsis.
PMID: 25623044 [PubMed - as supplied by publisher]