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Heptic Hydrothorax Predicts Higher One Year Mortality Compared to Patients with Refractory Ascites without Hydrothorax
Su1477
AASLD Abstracts
HEPTIC HYDROTHORAX PREDICTS HIGHER ONE YEAR MORTALITY COMPARED TO PATIENTS WITH REFRACTORY ASCITES WITHOUT HYDROTHORAX Ahmed Abdelfattah, Syed K. Mahmood, Sanaa Ayyoub, Frederic Gordon, Amir Qamar Purpose Hepatic hydrothorax (HHT) occurs in 5-10% of patients and is an important complication of cirrhosis. There is a paucity of data relating to how HHT impacts mortality compared with refractory ascites. This study evaluated the one-year mortality of patients with HHT compared to those with refractory ascites (RA) patients who did not have HHT. Methods Retrospective study design at a tertiary academic center. Study population consisted of cirrhotic patients referred to interventional radiology for thoracentesis or serial paracentesis between 2011 and 2015. Exclusion criteria included liver transplant recipients, other causes of pleural effusions, spontaneous bacterial empyema, or active malignancies (other than HCC). Demographic data, co-morbidities, and MELD-Na scores were also obtained. Thirty two patients with HHT who met inclusion/exclusion criteria were then matched with patients who had developed RA in the absence of HHT (matched to age, gender, and MELD-Na score). Primary outcome was 1 year mortality. Univariable and multivariable analysis were performed with 0.05 set as the alpha error. This study was approved by the institution's IRB. STATA 14 (College station, TX) was used for all statistical analysis. Results Sixty four patients met inclusion criteria (HHT= 32, RA= 32). The median age for HHT = 60 years and RA = 61.9 years. Median MELD-Na score for HHT = 17.6 and RA = 17.9. The one year mortality of HHT was 56.26% and RA 18.75% .Presence of hepatic hydrothorax was a significant predictor of one year mortality [univariable p<0.01; multivariate p< 0.01, OR= 6.90, CI(1.96, 24.24)]. We also performed a sub-group analysis looking at only patients with MELD-Na <20 (n=42) and MELD-Na <15 (n=30). HHT continued to be a significant predictor of one-year mortality in both groups [MELD-Na <20; p=0.02, OR=9.35, CI(1.48, 58.99)] and [MELD-Na <15; p=0.04, OR=7.0, CI(1.03, 47.68)]. Conclusion When compared to patients with RA, HHT was an independent predictor of one-year mortality, regardless of age, gender, MELD-Na score, renal function, HCC status, and occurrence of variceal bleeding. HHT patients should be considered for early liver transplantation including live donor liver transplantation and extended criteria grafts.
Su1478 COMPARISON OF COST OF CARE AND LENGTH OF STAY IN CIRRHOSIS PATIENTS HOSPITALIZED WITH ACUTE MYOCARDIAL INFARCTION: ANALYSIS FROM NATIONWIDE INPATIENT SAMPLE Kalpit H. Devani, Shilp Arora, Rajvee Patel, Chirag Savani, Ambarish Pathak, Kosha Thakore, Pranav Patel, Chakradhar M. Reddy BACKGROUND: There is paucity of data on resource utilization in cirrhosis patients hospitalized with Acute Myocardial Infarction (AMI). We aimed to compare length of stay (LOS) and cost of hospitalization amongst patients with and without cirrhosis hospitalized for AMI. METHODS: We queried the Nationwide Inpatient Sample (NIS) database from 2009-2012 to identify patients with primary diagnosis of AMI using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. After excluding patients with missing information on age, gender and inpatient mortality, we used ICD-9 codes to classify patients with and without Cirrhosis. Length of stay analysis was performed after excluding dead patients. Cost to charge ratio was merged and adjusted with inflation to calculate accurate cost for year 2012. Chi square was used to compare categorical variables and t-test was used to compare continuous variables. Hierarchical linear regression was used to generate predictors of length of stay and cost of care. All statistical tests were performed with a significance level set at 0.05. RESULTS: A total of 2,451,741patients with AMI were included, 16,457 (0.67%) of had cirrhosis. Cirrhosis was associated with longer length of stay (7.9 ± 0.2 vs. 4.7 ± 0.1, p<0.001) and higher cost of hospitalization ($25852 ± 616 vs. $19716 ± 30, p<0.001). After adjusting for confounding, similar results were observed in length of stay (LOS: +1.94 days, CI: +1.63 - +2.25, p<0.001) and cost (Cost +4873$, CI: +3635 - +6110, p<0.001). Other predictors of length of stay and cost of care are presented in figure. CONCLUSION: Cirrhosis is associated with higher length of stay and cost of hospitalization amongst the patients admitted with AMI.
AASLD Abstracts
Predictors of LOS and cost of hospitalization
Su1479 IMPACT OF CIRRHOSIS ON UTILIZATION OF INTERVENTIONS AND INPATIENT MORTALITY IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION: ANALYSIS OF NATIONWIDE INPATIENT SAMPLE Kalpit H. Devani, Shilp Arora, Rajvee Patel, Chirag Savani, Paris Charilaou, Ambarish Pathak, Kosha Thakore, Sajin Karakattu, Pranav Patel, Parag Brambhatt, Chakradhar M. Reddy Background: Impact of cirrhosis on patients hospitalized with acute myocardial infarction (AMI) is not well studied. The objective of this study is to assess the impact of cirrhosis on utilization of intervention/treatment and inpatient mortality in patients with AMI. Methods: Nationwide Inpatient Sample database from 2009-2012 was used to identify patients with primary diagnosis of AMI and patients with cirrhosis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Outcomes measured were use of percutaneous coronary intervention (PCI) and inpatient mortality. Chi square was used to compare categorical variables and t test for continuous variable. Hierarchical multivariate logistic regression was used to generate predictors of Inpatient mortality and PCI. All statistical tests were performed with a significance level set at 0.05. Results: Total of patients 2,451,741 with AMI were included, of which 16,457 (0.67 %) had cirrhosis. Mean age of the patient with cirrhosis was 66 years, 63.8% of patients were male and 61.9%
S-1144
AASLD Abstracts
HEPTIC HYDROTHORAX PREDICTS HIGHER ONE YEAR MORTALITY COMPARED TO PATIENTS WITH REFRACTORY ASCITES WITHOUT HYDROTHORAX Ahmed Abdelfattah, Syed K. Mahmood, Sanaa Ayyoub, Frederic Gordon, Amir Qamar Purpose Hepatic hydrothorax (HHT) occurs in 5-10% of patients and is an important complication of cirrhosis. There is a paucity of data relating to how HHT impacts mortality compared with refractory ascites. This study evaluated the one-year mortality of patients with HHT compared to those with refractory ascites (RA) patients who did not have HHT. Methods Retrospective study design at a tertiary academic center. Study population consisted of cirrhotic patients referred to interventional radiology for thoracentesis or serial paracentesis between 2011 and 2015. Exclusion criteria included liver transplant recipients, other causes of pleural effusions, spontaneous bacterial empyema, or active malignancies (other than HCC). Demographic data, co-morbidities, and MELD-Na scores were also obtained. Thirty two patients with HHT who met inclusion/exclusion criteria were then matched with patients who had developed RA in the absence of HHT (matched to age, gender, and MELD-Na score). Primary outcome was 1 year mortality. Univariable and multivariable analysis were performed with 0.05 set as the alpha error. This study was approved by the institution's IRB. STATA 14 (College station, TX) was used for all statistical analysis. Results Sixty four patients met inclusion criteria (HHT= 32, RA= 32). The median age for HHT = 60 years and RA = 61.9 years. Median MELD-Na score for HHT = 17.6 and RA = 17.9. The one year mortality of HHT was 56.26% and RA 18.75% .Presence of hepatic hydrothorax was a significant predictor of one year mortality [univariable p<0.01; multivariate p< 0.01, OR= 6.90, CI(1.96, 24.24)]. We also performed a sub-group analysis looking at only patients with MELD-Na <20 (n=42) and MELD-Na <15 (n=30). HHT continued to be a significant predictor of one-year mortality in both groups [MELD-Na <20; p=0.02, OR=9.35, CI(1.48, 58.99)] and [MELD-Na <15; p=0.04, OR=7.0, CI(1.03, 47.68)]. Conclusion When compared to patients with RA, HHT was an independent predictor of one-year mortality, regardless of age, gender, MELD-Na score, renal function, HCC status, and occurrence of variceal bleeding. HHT patients should be considered for early liver transplantation including live donor liver transplantation and extended criteria grafts.
Su1478 COMPARISON OF COST OF CARE AND LENGTH OF STAY IN CIRRHOSIS PATIENTS HOSPITALIZED WITH ACUTE MYOCARDIAL INFARCTION: ANALYSIS FROM NATIONWIDE INPATIENT SAMPLE Kalpit H. Devani, Shilp Arora, Rajvee Patel, Chirag Savani, Ambarish Pathak, Kosha Thakore, Pranav Patel, Chakradhar M. Reddy BACKGROUND: There is paucity of data on resource utilization in cirrhosis patients hospitalized with Acute Myocardial Infarction (AMI). We aimed to compare length of stay (LOS) and cost of hospitalization amongst patients with and without cirrhosis hospitalized for AMI. METHODS: We queried the Nationwide Inpatient Sample (NIS) database from 2009-2012 to identify patients with primary diagnosis of AMI using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. After excluding patients with missing information on age, gender and inpatient mortality, we used ICD-9 codes to classify patients with and without Cirrhosis. Length of stay analysis was performed after excluding dead patients. Cost to charge ratio was merged and adjusted with inflation to calculate accurate cost for year 2012. Chi square was used to compare categorical variables and t-test was used to compare continuous variables. Hierarchical linear regression was used to generate predictors of length of stay and cost of care. All statistical tests were performed with a significance level set at 0.05. RESULTS: A total of 2,451,741patients with AMI were included, 16,457 (0.67%) of had cirrhosis. Cirrhosis was associated with longer length of stay (7.9 ± 0.2 vs. 4.7 ± 0.1, p<0.001) and higher cost of hospitalization ($25852 ± 616 vs. $19716 ± 30, p<0.001). After adjusting for confounding, similar results were observed in length of stay (LOS: +1.94 days, CI: +1.63 - +2.25, p<0.001) and cost (Cost +4873$, CI: +3635 - +6110, p<0.001). Other predictors of length of stay and cost of care are presented in figure. CONCLUSION: Cirrhosis is associated with higher length of stay and cost of hospitalization amongst the patients admitted with AMI.
AASLD Abstracts
Predictors of LOS and cost of hospitalization
Su1479 IMPACT OF CIRRHOSIS ON UTILIZATION OF INTERVENTIONS AND INPATIENT MORTALITY IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION: ANALYSIS OF NATIONWIDE INPATIENT SAMPLE Kalpit H. Devani, Shilp Arora, Rajvee Patel, Chirag Savani, Paris Charilaou, Ambarish Pathak, Kosha Thakore, Sajin Karakattu, Pranav Patel, Parag Brambhatt, Chakradhar M. Reddy Background: Impact of cirrhosis on patients hospitalized with acute myocardial infarction (AMI) is not well studied. The objective of this study is to assess the impact of cirrhosis on utilization of intervention/treatment and inpatient mortality in patients with AMI. Methods: Nationwide Inpatient Sample database from 2009-2012 was used to identify patients with primary diagnosis of AMI and patients with cirrhosis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Outcomes measured were use of percutaneous coronary intervention (PCI) and inpatient mortality. Chi square was used to compare categorical variables and t test for continuous variable. Hierarchical multivariate logistic regression was used to generate predictors of Inpatient mortality and PCI. All statistical tests were performed with a significance level set at 0.05. Results: Total of patients 2,451,741 with AMI were included, of which 16,457 (0.67 %) had cirrhosis. Mean age of the patient with cirrhosis was 66 years, 63.8% of patients were male and 61.9%
S-1144