Comparative analysis and trends in liver transplant hospitalizations with Clostridium difficile infections: A 10-year national cross-sectional study.

GOALS AND BACKGROUND: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations. METHODS: The national inpatient sample database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009 to 2019. Primary outcomes included 10-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends. RESULTS: There was a 14.05% decrease in CDI in LT hospitalizations over the study period (p = .05). The trend in LOS did not significantly vary (p = .9). MIC increased significantly over the last decade in LT hospitalizations with CDI (p < .001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI] 0.75-1.26, p = .87). CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 (95% CI 1.52-2.24, p < .001). In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (p = .3). CDI increased transplant rejections, aOR 1.3 (95% CI 1.08-1.65, p < .001). There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (p = .0048). CONCLUSION: CDI prevalence does not increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade.

Outcomes of endoscopic retrograde cholangiopancreatography-guided gallbladder drainage compared to percutaneous cholecystostomy in acute cholecystitis.

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography-guided gallbladder drainage (ERGD) is an alternative to percutaneous cholecystostomy (PTC) for hospitalized acute cholecystitis (AC) patients. Methods: We retrospectively analyzed propensity score matched (PSM) AC hospitalizations using the National Inpatient Sample database between 2016 and 2019 to compare the outcomes of ERGD and PTC. Results: After PSM, there were 3,360 AC hospitalizations, with 48.8% undergoing PTC and 51.2% undergoing ERGD. There was no difference in median length of stay between the PTC and ERGD cohorts (p = 0.110). There was a higher median hospitalization cost in the ERGD cohort, $62,562 (interquartile range [IQR] $40,707-97,978) compared to PTC, $40,413 (IQR $25,244-65,608; p < 0.001). The 30-day inpatient mortality was significantly lower in hospitalizations with ERGD compared to PTC (adjusted hazard ratio 0.16, 95% confidence interval [CI]: 0.1-0.41; p < 0.001). There was no difference in association with blood transfusions, acute renal failure, ileus, small bowel obstruction, and open cholecystectomy conversion (p > 0.05) between hospitalizations with ERGD and PTC. There was lower association of acute hypoxic respiratory failure (adjusted ratio [AOR] 0.46, 95% CI: 0.29-0.72; p = 0.001), hypovolemia (AOR 0.66, 95% CI: 0.49-0.82; p = 0.009) and higher association of lower gastrointestinal bleed (AOR 1.94, 95% CI: 1.48-2.54; p < 0.001) with ERGD compared to PTC. Conclusions: ERGD is a safer alternative to PTC in patients with AC. The risk complications are lower in ERGD compared to PTC but no difference exists based on mortality or conversion to open cholecystectomy.

Simple scoring for acute necrotizing pancreatitis: mortality in acute necrotizing pancreatitis during admission (MANP-A).

Background: Acute necrotizing pancreatitis (ANP) can result in a significant healthcare burden. The present study aimed to develop a new scoring system to accurately and promptly identify patients with a high likelihood of mortality to determine the need for aggressive measures. Methods: We retrospectively analyzed patients diagnosed with ANP using the National Inpatient Sample (NIS). The mortality in ANP during admission (MANP-A) scoring system was derived using multivariate Cox regression analysis and validated using receiver operating characteristic (ROC) curves in a validation cohort. Results: A total of 22,980 hospitalizations were identified in the derivation cohort. There was a predominance of males (65%) and white race (73%). Five variables showed significant association with mortality and were selected for developing the MANP-A scoring system: age ≥60 years; acute renal failure/kidney injury; sepsis with shock; vasopressor use; and disseminated intravascular coagulation. The MANP-A score has a maximum of 5 points and the cutoff for predicting mortality was set at 2 points. The area under the curve (AUC) using the ROC curve of the derivation cohort was 0.9195, 95% confidence interval [CI] 0.8838-0.9551 (P<0.001) for 7- and 0.8954, 95%CI 0.8723-0.9185 (P<0.001) for 30-day periods. The AUC of the Validation Cohort was 0.9204, 95%CI 0.8937-0.9469 (P<0.001) for 7- and 0.9059, 95%CI 0.8893-0.9223 (P<0.001) for 30-day periods. Conclusion: We propose a simple and objective score for predicting ANP inpatient mortality at 7- and 30-day intervals with high validity.

Relation between inflammatory bowel disease, depression, and inpatient outcomes in the United States.

The relationship between inflammatory bowel disease (IBD) and depression is complicated. The effect of depression on ulcerative colitis (UC) and Crohn's disease (CD) among the inpatient US population has not previously been studied. We retrospectively analyzed patients admitted with UC and CD from 2016 to 2019 using the National Inpatient Sample database. Our primary outcome was the effect of depression on hospital length of stay (LOS), costs, and mortality. Secondary outcomes included the comparison between UC and CD cases. In the UC population, 13.4% had depression, compared to 14.9% in the CD population. LOS was longer in UC and CD patients with depression (P < 0.001). Subgroup analysis revealed that LOS was longer in CD patients than UC patients in the depressed cohort (P < 0.001). Inpatient hospital costs were lower in IBD patients with depression (P < 0.001). Subgroup analysis revealed that hospital cost was $17,974 higher in CD patients than UC patients (P < 0.001). Depression did not increase mortality in the IBD population but increased LOS, with a greater impact on CD than UC. White women were found to have an increased prevalence of depression in the IBD population.

Ten-year trends and prediction model of 30-day inpatient mortality for alcoholic hepatitis in the United States.

Background: Alcoholic hepatitis (AH) results in significant morbidity, mortality and healthcare burden. We aimed to evaluate the temporal trends of AH hospitalizations in the last decade and to devise a mortality scoring system for risk stratification. Methods: National Inpatient Sample (NIS) databases from 2009-2019 were used to identify AH hospitalizations. Outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), mortality, and mortality predictors. A mortality scoring system was derived using multivariate Cox regression and validated using receiver operating characteristic curves. Results: There was an increase in total AH hospitalizations, from 67,070 in 2009 to 125,540 in 2019 (P=0.004). The inpatient mortality increased from 2.48% in 2009 to 3.78% in 2019 (P=0.008). The MIC was $31,189 in 2009 and $62,229 in 2019 (P<0.001). A trend for LOS was not significant. Ten variables were selected for incorporation into a risk score, including anemia, age >60 years, female sex, mechanical ventilation, vasopressor use, spontaneous bacterial peritonitis, hepatorenal syndrome, acute renal failure, coagulopathy (thrombocytopenia), and hepatic encephalopathy. The score has a maximum of eight points, and the cutoff for predicting mortality was set as 4 points. The area under the curve (AUC) of the derivation cohort was 0.8766 (95% confidence interval [CI] 0.865-0.888) and AUC 0.862 (95%CI 0.855-0.868) for a 30-day period. Conclusions: There has been an increase in AH hospitalizations and mortality in the last decade. The Tahira score provides an easy objective method to estimate inpatient 30-day mortality for AH hospitalizations.

Inpatient outcomes and racial disparities of palliative care consults in mechanically ventilated patients in the United States.

Intensive care units (ICUs) account for a disproportionately large share of healthcare utilization. Our study examined the association between palliative care consults (PCC) and hospital outcomes in mechanically ventilated patients. We analyzed patients admitted from 2016 to 2019 using the National Inpatient Sample database. The primary outcome was the association of PCC and length of stay; secondary outcomes included the impact of PCC on total hospital costs. Of the 2,351,503 patients included, 15.5% had a PCC, with a male predominance (53%, P < 0.001). Whites had a higher PCC rate, at 167 per 1000 ICU cases, vs. Blacks, at 25 per 1000 cases (P < 0.001). Adjusted length of stay was 2.0 days less in patients with PCC (P < 0.001), and adjusted inpatient hospital cost was $12,942 lower in patients with PCC (P < 0.001). Whites had a larger decrease in length of stay and costs compared to blacks, Hispanics, and Asians (P < 0.001). In conclusion, PCC was associated with a shorter length of stay and lower inpatient hospital costs in critically ill ICU patients. Black patients saw a lower impact of PCC on LOS and hospital costs, as well as a lower rate of PCC.

Inpatient outcomes of Dieulafoy's lesions in the United States.

Dieulafoy's lesions are arguably underidentified rather than an infrequent cause of gastrointestinal bleeding. No population-based study exists regarding its inpatient outcomes in the United States. We evaluated the characteristics and inpatient outcomes for Dieulafoy's lesions using the National Inpatient Sample from 2016 to 2019. We identified 30,015 weighted hospitalizations for Dieulafoy's lesions. An initial diagnosis of Dieulafoy's lesions was established for 53.85% of patients on admission. The mean age was 68.7 ± 0.04 years, with male (56%) and white race predominance (70%). The mean length of stay and hospital cost were 7.87 days and $111,914, respectively. Significant predictors of inpatient mortality included heart failure, cardiac arrhythmias, coagulopathy, protein-calorie malnutrition, and alcoholism (P < 0.001). During inpatient hospitalization, 78% of patients underwent endoscopies, and 11% had colonoscopies. Inpatient mortality was 4.65%. Common comorbidities in Dieulafoy's lesions patients included heart failure (34%), cardiac arrhythmias (41%), hypertension (32%), chronic obstructive pulmonary disorders (25%), coagulopathic disorders (22%), and alcohol abuse (12%). Dieulafoy's lesions have a significant effect on length of stay and hospital cost. Endoscopies were used substantially more than colonoscopies for Dieulafoy's lesions, indicating a predominant presentation as upper gastrointestinal bleed. Cardiac disorders increase mortality in patients with Dieulafoy's lesions.