Hospitalizations for Acute on Chronic Liver Failure at Academic Compared to Non-academic Centers Have Higher Mortality

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dc.contributor.authorSingal, Ashwani K.
dc.contributor.authorAhmed, Zunirah
dc.contributor.authorAxley, Page
dc.contributor.authorArora, Sumant
dc.contributor.authorArab, Juan P.
dc.contributor.authorHaas, Allen
dc.contributor.authorKuo, Yong-Fang
dc.contributor.authorKamath, Patrick S.
dc.date.accessioned2025-01-20T23:56:24Z
dc.date.available2025-01-20T23:56:24Z
dc.date.issued2021
dc.description.abstractBackground and Aim Acute on chronic liver failure (ACLF) in patients with cirrhosis has high short-term mortality. Data comparing ACLF admissions to academic centers (AC) and non-academic centers (NAC) are scanty. Methods National Inpatient Sample (2006-2014) was queried for admissions with cirrhosis and ACLF using the ICD-09 codes, and was stratified to AC or NAC. Results Of 1,928,764 admissions with cirrhosis (2006-2014), 112,174 (5. 9%) had ACLF. 6.7% of 1,018,568 cirrhosis admissions to AC had ACLF versus 5% of 910,196 admissions to NAC, P < 0.0001. Proportion of ACLF admissions to AC increased from 49% during 2006-2008 to 59% during 2012-2014. In a cohort of 73,630 ACLF admissions (36,615 each to AC and NAC) matched for patient demographics, cirrhosis etiology, number of comorbidities, elective versus emergent admission, ACLF grade, and type of organ failure. In-hospital mortality declined by 7% over the study period, but remained higher in AC (46% vs. 42%, P < 0.001), with 11% increased odds for in-hospital mortality compared to admission to NAC. Further admissions to AC versus NAC had higher median (IQR) length of stay at 13 (6-25) versus 11 (5-20) days, with higher median (IQR) hospital charges: 138,239 (66,772-275,603) versus 116,209 (55,767-232,699) USD, P < 0.001 for both. Conclusion Patients with ACLF have high in-hospital mortality. Further, this is higher among admissions to AC. Although the in-hospital mortality is improving, strategies are needed on early identification of patients with futility of care for early discussion on goals of care, and optimal utilization of hospital resources among admissions with ACLF.
dc.fuente.origenWOS
dc.identifier.doi10.1007/s10620-020-06263-w
dc.identifier.eissn1573-2568
dc.identifier.issn0163-2116
dc.identifier.urihttps://doi.org/10.1007/s10620-020-06263-w
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/95151
dc.identifier.wosidWOS:000528132300001
dc.issue.numero4
dc.language.isoen
dc.pagina.final1314
dc.pagina.inicio1306
dc.revistaDigestive diseases and sciences
dc.rightsacceso restringido
dc.subjectACLF
dc.subjectCirrhosis
dc.subjectAdmissions
dc.subjectResources
dc.subjectHealth care burden
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleHospitalizations for Acute on Chronic Liver Failure at Academic Compared to Non-academic Centers Have Higher Mortality
dc.typeartículo
dc.volumen66
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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