Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations

Aalam Sohal; Hunza Chaudhry; Dino Dukovic; Kris V Kowdley

doi:10.1002/jgh3.12985

Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations

JGH Open. 2023 Nov 27;7(12):848-854. doi: 10.1002/jgh3.12985. eCollection 2023 Dec.

Authors

Aalam Sohal¹, Hunza Chaudhry², Dino Dukovic³, Kris V Kowdley^{1

4}

Affiliations

¹ Department of Hepatology Liver Institute Northwest Seattle Washington USA.
² Department of Internal Medicine University of California Fresno California USA.
³ Department of Medicine Ross University School of Medicine Miramar Florida USA.
⁴ Department of Medicine, Elson S. Floyd College of Medicine Washington State University Pullman Washington USA.

Abstract

Background and aim: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States.

Methods: Patients with HRS were identified from the national inpatient sample 2016-2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non-teaching hospitals (NTHs), teaching non-transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in-hospital mortality and transplant-free mortality was examined using multivariable linear and logistic regression analysis.

Results: A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non-TTCs (aOR = 0.75, 95% CI: 0.68-0.83, P <0.001). Patients at TTCs had a lower transplant-free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67-0.83, P < 0.001). There was no significant difference in all-cause or transplant-free mortality between TNTCs and NTHs.

Conclusion: Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS.

Keywords: hepatorenal syndrome; national inpatient sample; outcomes; teaching status; transplant status.