Trends in Hospitalization for a Population-Based Cohort with Cirrhosis and Multiple Chronic Conditions: time to change the definition of decompensated cirrhosis?
AASLD LiverLearning®. Asrani S. Nov 14, 2016; 144928
Dr. Sumeet Asrani
Dr. Sumeet Asrani
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TITLE: Trends in Hospitalization for a Population-Based Cohort with Cirrhosis and Multiple Chronic Conditions: time to change the definition of decompensated cirrhosis?


Background: Decompensated cirrhosis is traditionally defined by complications of portal hypertension. In a population based study, we examined time trends in chronic liver disease (CLD) related admissions in a large and diverse metroplex.
Methods:We examined all CLD related encounters (2000-2015) in Dallas-Fort Worth (DFW) using data from the DFW council collaborative, a unique resource capturing data from all hospital admissions (95% of all hospitals, 17 counties, catchment area of 7 million). The population of this 4th largest metroplex is diverse and representative of the US population.
Results: There were 105,957 CLD related admissions in 60,543 unique patients across 84 hospitals. In 2015, the mean age was 57 years, 69% were Caucasian, 15% Hispanic ethnicity and 43% were women. The most common primary cause for admission was sepsis, hepatic encephalopathy, and complications of alcoholic cirrhosis. Between 2000 and 2015, crude annual prevalence rate of CLD related admissions increased 4-fold from 624/100,000 to 2,268/100,000. Mean age at admission changed from 54.0 year (2000) to 58.2 years (2015); the number of CLD patients above 65 years increased from 24.2 to 33.1%.
As compared to 2000, the number of patients with co-morbidities increased from 4.4% to 13% (CAD), 2.6% to 14.1% (obesity), 0.9% to 21.6% (dyslipidemia), 2.8% to 21.6% (chronic kidney disease), and 19.7% to 37.2% (DM). Admissions for complications of portal hypertension remained stable; complication related to infection and renal failure increased. (Figure) Infection related admission was driven by increases in sepsis (30%). There was a 3 fold increase in C difficile rates (1.15 to 4.6%). Renal related admissions were driven by hyponatremia, volume overload or depletion (30%).
Conclusions: CLD related admissions have increased 4 fold over the last decade. CLD patients are older and sicker with multiple chronic conditions. Traditional complications of portal hypertension (e.g. variceal bleeding) have been supplanted by infection and renal failure, warranting a need to re-define what it means to have decompensated cirrhosis.

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