studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 475A
533
Charges for Patients Hospitalized with Alcoholic Cirrhosis
Exceed All Other Etiologies of Cirrhosis Combined
and are Driven by Readmissions and Volume
Monica Schmidt 1 , Paul H. Hayashi 2 , Ramon Bataller 2 , Alfred S.
Barritt 2 ; 1 UNC Liver Center & Gillings School of Global Public
Health, University of North Carolina Chapel Hill, Chapel Hill, NC;
2 UNC Liver Center, Chapel Hill, NC
Background:Total charges for hospitalized patients with cirrhosis
are greater for alcoholic liver disease than for all other
etiologies of cirrhosis combined. It is not known if costs are
driven by a higher volume of hospitalizations, longer stays,
or readmissions. Methods:We used the HCUP State Inpatient
Database (SID) files for New York and Florida to determine
costs, readmission rates, and predictors of 30-day readmission
for patients with cirrhosis from 2010-2012. The SID
provides longitudinal data for individual patients. A random
effects model was used to evaluate predictors of 30 day readmissions.
Results:215,886 discharges and 96,295 patients
with cirrhosis were identified. Alcoholic cirrhosis accounted
for 53% of total admissions and 51% of cirrhosis related
inpatient charges, totaling $6B between 2010-2012. Costs
per admission were $53,838 for alcohol and $56,326 for
non-alcoholics. Alcoholics had greater aggregate charges at
the index admission and 30, 60 and 90 days(Figure 1). 30
day readmission rates were 14% for alcoholics and 12% for
non-alcoholics(p
31 IU/L in women, ALT> 40 IU/L or AST> 37 IU/L in men)
and excessive alcohol use (>20 g/day in men, >10 g/day in
women). Hepatitis C (HCV) infection was defined as detectable
HCV RNA. Presumed NAFLD was defined as elevated liver
enzymes in the absence of indicators of chronic hepatitis B
and C infection (negative antibody serology) and no excessive
alcohol use. Type 2 diabetes (DM) was defined as the use of
glucose-lowering agents or fasting blood glucose >125 mg/dL.
The NHANES medical history questionnaire was used to determine
the presence of major chronic diseases (cardiovascular,
pulmonary, renal, malignancies) which were further tested as
predictors of mortality in a Cox proportional hazard model.
Results: In 1999-2012, 11,726 BB subjects [age at enrollment
50.2±0.3 years, 72.5% White, 10.9% Hispanics, 11.4% African-American,
36.5% obese (BMI≥30), 10.6% with DM] were
included. The most common cause of CLD in BB was NAFLD
(11.08% of BB population), followed by ALD (2.82%) and HCV
(2.27%). These prevalence rates in the leading-edge BB and
late BB were: NAFLD: 10.4±0.6% vs. 11.7±0.6%, p=0.11;
ALD: 2.0±0.3% vs. 3.5±0.4%, p=0.0044, HCV: 2.8±0.3% vs.
3.6±0.4%, p=0.09. During average 92.4 months of follow-up,
355 (3.84%) BB participants with mortality data died. Multivariate
analysis showed that HCV infection [adjusted hazard ratio
(aHR) = 2.06 (1.03-4.11)] was independently associated with
increased mortality in BB. Additionally, older age [aHR = 1.05
(1.02-1.08) per year], DM [HR = 1.90 (1.21-2.98)], hypertension
[aHR = 2.19 (1.58-3.04)], excessive alcohol use [aHR
= 2.62 (1.73-3.97)], the presence of cardiovascular diseases
[aHR = 1.70 (1.06-2.72)], and chronic kidney disease [aHR =
3.46 (1.87-6.39)] were associated with mortality in BB population.
Conclusions: NAFLD, ALD and HCV are common causes
of CLD in BB. However, only HCV remains an independent
CLD predictor of mortality in BB cohort. As more HCV patients
are being cured, NAFLD will most likely account for most of the
CLD burden in the BB cohort.
Disclosures:
Zobair M. Younossi - Advisory Committees or Review Panels: Salix, Janssen,
Vertex; Consulting: Gilead, Enterome, Coneatus
Aijaz Ahmed - Consulting: Bristol-Myers Squibb, Gilead Sciences Inc., Roche,
AbbVie, Salix Pharmaceuticals, Janssen pharmaceuticals, Vertex Pharmaceuticals,
Three Rivers Pharmaceuticals; Grant/Research Support: Gilead Sciences
Inc.