Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations

• Published in: JGH open Vol. 7; no. 12; pp. 848 - 854
• Main Authors: Sohal, Aalam, Chaudhry, Hunza, Dukovic, Dino, Kowdley, Kris V.
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.12.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Creatinine; Demographics; Family income; hepatorenal syndrome; Hospitalization; Liver diseases; Medicare; Mortality; national inpatient sample; Original; outcomes; Patients; Teaching hospitals; teaching status; transplant status; Transplants & implants; United States > US; transplant status; national inpatient sample; outcomes; teaching status; hepatorenal syndrome
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12985

Background and Aim Hepatorenal syndrome (HRS) is a life‐threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States. Methods Patients with HRS were identified from the national inpatient sample 2016–2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non‐teaching hospitals (NTHs), teaching non‐transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in‐hospital mortality and transplant‐free mortality was examined using multivariable linear and logistic regression analysis. Results A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non‐TTCs (aOR = 0.75, 95% CI: 0.68–0.83, P <0.001). Patients at TTCs had a lower transplant‐free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67–0.83, P < 0.001). There was no significant difference in all‐cause or transplant‐free mortality between TNTCs and NTHs. Conclusion Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS. Study shows that patients with hepatorenal syndrome admitted to teaching transplant centers have better outcomes compared to patients admitted to teaching non‐transplant centers and non‐teaching centers, regardless of whether they receive the transplant or not.