Original article—liver, pancreas, and biliary tract
Nationwide Increase in Hospitalizations and Hepatitis C Among Inpatients With Cirrhosis and Sequelae of Portal Hypertension

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Background & Aims: Advanced liver disease and complications of portal hypertension are common indications for hospitalization. Our objectives were to characterize longitudinal trends in incidence, characteristics, and outcomes of patients hospitalized with complications of portal hypertension using a nationally representative data set. Methods: Admissions for complications of portal hypertension (hepatic encephalopathy, ascites, or variceal bleed) were identified from the Nationwide Inpatient Sample between 1998 and 2003 using International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. International Classification of Diseases, 9th Revision, Clinical Modification procedural codes were used to identify liver transplantation and portosystemic shunt procedures. National estimates for incidence of hospitalization over time, in-hospital mortality, and hospital charges accounted for survey design. Results: Hospitalization rates increased significantly by 5% annually between 1998 and 2003, particularly in the Northeast and the South. The prevalence of hepatitis C–related advanced liver disease among these hospitalized patients increased from 12.9% to 23.7%, and in those with HCV and concurrent alcohol-related disease the rate increased from 5.6% to 11.2%. US population–based in-hospital mortality increased modestly from 1.9 to 2.1 per 100,000 (P<.001), with hepatorenal syndrome as the strongest predictor of death (odds ratio, 9.5; 95% confidence interval, 8.4–10.7). The inflation-adjusted total economic burden of decompensated cirrhosis increased from $1.15 billion to $2.1 billion during the 6-year period (P<.003). Conclusions: A significant increase in the incidence of hospitalization for complicated portal hypertension between 1998 and 2003 and a growing burden of hepatitis C–related disease have profound economic impact and underscore the need for interventions to prevent progression to advanced liver disease.

Section snippets

Data Source

All data were extracted from the NIS between 1998 and 2003. It is the largest all-payer database of national hospital discharges, maintained as part of the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality. The NIS is a 20% stratified sample of nonfederal, acute-care hospitals in the United States. This sample includes community and general hospitals and academic medical centers, but excludes long-term facilities. Each record in the NIS represents a

Rates of Hospitalization

The overall rate of hospitalization for cirrhosis complicated by portal hypertension among all individuals in the US census was 23.6 per 100,000 persons annually between 1998 and 2003. Stratified by year, the annual incidence of hospitalization was 21.4 per 100,000 in 1998, 21.7 per 100,000 in 1999, 22.7 per 100,000 in 2000, 23.5 per 100,000 in 2001, 25.4 per 100,000 in 2002, and 26.6 per 100,000 in 2003. On average, there was a statistically significant 5% annual increase in hospitalization

Discussion

In this national study, we found an increase in the estimated incidence of hospitalizations for cirrhosis and complications of portal hypertension in a relatively short 6-year period. We also observed a concurrent increase in the proportion of patients with decompensated cirrhosis with HCV infection. There was a concomitant increase in the total economic burden arising from hospitalizations for complications of portal hypertension that was most pronounced among the subgroup with HCV infection

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    Supported by a Ruth L. Kirschstein individual postdoctoral fellowship grant by the National Institutes of Health (F32DK076257, G.C.N.).

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