Trends and Outcomes in Mechanically Ventilated Cirrhotic Patients
CCCF ePoster library. Cheung K. Nov 9, 2018; 233341
Disclosure(s): College of Medicine, University of Saskatchewan
Kyle Cheung
Kyle Cheung
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Abstract
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Background

Cirrhotic patients who receive mechanical ventilation are known to have exceptionally poor outcomes, with a reported mortality rate in excess of 35%1,2. In this study, we analyzed Healthcare Cost and Utilization Project (HCUP) National Inpatient Study (NIS) database to learn more about this high-risk population.



Objectives

The purpose of this study was to examine the impact of various comorbidities and/or interventions on mortality in this patient subpopulation. Further, we examined the impact of these factors on hospital length of stay (LOS) as well as the total financial cost per hospitalization. 



Methods

A retrospective analysis was performed on the HCUP NIS database from years 2005-2014. To select our subpopulation, the following inclusion criteria were applied: a) over the age of 18 years; b) assigned a diagnosis of cirrhosis (International Classification of Diseases 9th edition [ICD-9] code 571) and c) assigned an ICD-9 procedure code for mechanical ventilation (96.7). Multiple regression was used to assess the association between specific patient factors on in-hospital mortality, LOS and total hospital charges while adjusting for age, sex, race, Charlson comorbidity category, primary payer source, median income in the patient’s residential area, elective versus emergency admission, location, size, and teaching status.



Results

In the general mechanically ventilated inpatient population, in-hospital mortality was 27.7% (95% confidence interval [CI] 26.7; 28.7%) and amongst mechanically ventilated cirrhotics was 41.8% (95% CI 39.9; 43.7%). Multivariate analysis showed several comorbidities that were associated with an increased likelihood of in-hospital mortality, including hepatorenal syndrome, odds ratio (OR) 3.24 (95% CI 3.02; 3.47); sepsis, OR 3.23 (95% CI 3.11; 3.37) and renal failure, OR= 2.84 (95% CI 2.74; 2.94).



The average LOS in the mechanically ventilated population was 14.9 (95% CI 14.7; 15.2), and in our sub-population was 12.9 days (95% CI 12.7; 13.2). Certain procedures were associated with increased hospital LOS, such as receiving a tracheostomy, 24.8 days (95% CI 23.3; 26.3); liver transplant, 21.1 days (95% CI 17.6; 24.7); and hemodialysis, 5.0 days (95% CI 4.5; 5.5).



The average cost per hospitalization in mechanically ventilated patients without cirrhosis was $148,792 (95% CI $145,039; 152,546) in our sub-population was $152,653 (95% CI $146,981; 158,325).Total hospital charges were also strongly influenced by procedures such as receiving a liver transplant, $440,493 (95% CI $390,030; 490,957); tracheostomy, $290,898 (95% CI $272,361; 309,436) and hemodialysis, $100,271 (95% CI $89,940; 110,602).

 

Conclusions

There are several comorbidities associated with increased mortality amongst mechanically ventilated cirrhotic patients, including hepatorenal syndrome, sepsis, and renal failure. Procedures on this high-risk population were generally associated with improved mortality rates but significantly longer hospital stays and higher financial costs.

Our results reinforce the notion that mechanically ventilated cirrhotics are a high-risk and expensive population with generally poor outcomes. Patients with impaired renal function and suspected sepsis should be treated carefully as they have an even greater risk of in-hospital mortality. Our work outlines a need for further investigation in order to better manage and treat this subpopulation of patients.   

 


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