Impact of Transfer Status on Outcomes in Hospitalized Patients with Hepatorenal Syndrome

Abstract

AIM: To examine the impact of transfer status on outcomes in patients hospitalized with hepatorenal syndrome at the population level.

MATERIALS AND METHODS: Using a national database, we performed a retrospective study on all adult (≥ 18 years) with HRS between 2012-2014. All hospitalizations involving any form of chronic kidney disease were excluded. The primary outcome was in-patient mortality, and the secondary outcomes were chronic liver disease complications and healthcare resources utilization (hospital stay and cost). Outcomes were compared between those who were directly admitted and those who were transferred from another hospital.

RESULTS: 49,190 unweighted hospitalizations met the inclusion criteria with 8,160 (16.5%) in the transfer group. The transfer group had higher mortality (41.5% vs 36.0%). On multivariate logistic regression, the transfer group had significantly higher odds of mortality (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.21 – 1.53), spontaneous bacterial peritonitis (OR 1.37, 95% 1.17 – 1.59), hepatic coma (OR 1.18, 95% CI 1.05 – 1.32), dialysis (OR 1.97, 95% CI 1.68 – 2.30), transjugular intrahepatic portosystemic shunt (OR 1.77, 95% CI 1.15 – 2.72), liver transplant (OR 2.59, 95% CI 1.97 – 3.40), and incurred an incremental cost of $9,693 ($6,023 – $13,363). However, the odds of variceal bleeding and incremental length of stay were not statistically significant.

CONCLUSION: Patients transferred with HRS to another hospital had worse outcomes compared to directly admitted patients and incurred higher hospitalization costs.