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NASH is most rapidly growing etiology for acute-on-chronic liver failure related hospitalization and disease burden in the US.
Liver Transpl. 2019 Mar 12;:
Authors: Axley P, Ahmed Z, Arora S, Haas A, Kuo YF, Kamath PS, Singal AK
Abstract
BACKGROUND & AIMS: Acute on chronic liver failure (ACLF) among patients with cirrhosis is characterized by multiple organ failure (OF) with high short-term mortality. There is lack of population based data on trends on ACLF related morbidity and disease burden based on liver disease etiology.
METHODS: National Inpatient Sample (2006-2014) was queried using the ICD-09 codes for admissions with cirrhosis and ACLF (defined with ≥2 extrahepatic organ failures).
RESULTS: Of 1,928,764 admissions for cirrhosis between 2006 and 2014, 112,174 (5.9%) had ACLF (4.5, 1.2, and 0.2% with ACLF-1, 2, and 3 respectively). Brain was most common organ failure in 12%, followed by lung in 7.7%, cardiac in 6.3%, and renal in 5.6%. ACLF increased by 24% between 2006 and 2014, with 63% increase in 179,104 NASH cirrhosis (3.5 to 5.7%), 28% in 429,306 alcoholic cirrhosis (5.6 to 7.2%), 25% in 1091,053 with other etiology (5.2 to 6.5%), and no significant change in 229,301 patients with viral cirrhosis (4.0 to 4.1%). In-hospital mortality was higher among ACLF compared to no ACLF (44 vs.4.7%, P<0.0001). Each NASH related ACLF patient compared to other etiologies had mean length of stay (14 vs. 12 d) and associated with higher median total charges ($151,196 vs. $134,597), more frequent use of dialysis (45 vs. 36%), and long-term care (32 vs. 26%), P<0.0001 for all. Results remained similar in a subgroup analysis after including half of admissions with cryptogenic cirrhosis as NASH.
CONCLUSIONS: NASH cirrhosis is most rapidly growing indication for ACLF related hospitalization and use of hospital resources. In the setting of improved treatment options for chronic hepatitis, the healthcare burden of chronic viral-related liver disease remains stable. Population based strategies are needed to reduce healthcare burden of cirrhosis, particularly related to NASH. This article is protected by copyright. All rights reserved.
PMID: 30861321 [PubMed - as supplied by publisher]