Background: The number of hospitalizations related to a primary diagnosis of cirrhosis has been declining since the mid-2000’s. However, the temporal trend of number of hospitalizations and inpatient mortality associated with secondary conditions of cirrhosis remains uncertain. Therefore, we conducted a nationwide population data analysis to show the temporal correlation of hospitalizations and mortality associated with four common secondary conditions of cirrhosis.
Methods: We utilized data from Healthcare Cost and Utilization Project published by Agency for Healthcare Research and Quality to obtain population data from 2005 to 2014 related to inpatient diagnosis of cirrhosis, hepatic coma (HC), intraabdominal venous shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) using ICD-9 codes. We compared the temporal trend of total number of discharges and mortalities using simple linear regression and correlation analysis.
Results: From 2005 to 2014, the total number of discharges with cirrhosis significantly decreased (2005: 86913 and 2014: 77880 total discharges, r=-0.79, p=0.007), while the four cirrhosis related pathologies were all trending up (HC, 46172 to 69145; TIPS, 4713 to 6530; EV, 3941 to 4305; SBP, 821 to 7545; from 2005 to 2014, respectively; four correlations ranging 0.73-0.96, ps<0.016). The overall sum of total number of discharges of combined 5 conditions tended to go up and consistently increased in recent 6 consecutive years, from 2009: 141933 to 2014: 165405. SBP discharges had the highest annual increase rates, 2006: 3770 (i.e., 459.23% annual increase rate against 2005) and then 200.15% increase in 9 years from 2006 to 2014.In-hospital mortality significantly decreased over time (2005: 9.02% (cirrhosis), 8.06% (HC), 8.34% (SBP) to 2014: 5.62%, 5.73%, 6.16% respectively; ps<0.005) except for EV (2005: 5.84% to 2014: 6.04%; p=0.35). Interestingly, cirrhosis discharges, deaths and mortalities all monotonically decreased in 6 consecutive years, by 15.64%, 38.43% and 48.06%, respectively for 2010 relative to 2004 data; and then almost stayed in a stable level in 2011-2014; while the estimated average life savings count per year were 735, p=0.0002.
Conclusions: As the mortality rate for cirrhosis and associated conditions decreased, the number of discharges related to HC, TIPS and SBP increased despite decreasing cirrhosis discharges. Further prospective studies are needed to find the explanations of these trends.