Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

Table 1 Demographic and hospital data¹

	Percent	χ2P value
Age (yr)		< 0.001
0-9	0.9%
10-19	1.3%
20-29	2.6%
30-39	6.3%
40-49	22.4%
50-59	33.0%
60-69	20.8%
70-79	10.4%
80-89	2.3%
90-99	0.1%
Age > 70	11.4%	< 0.001
Sex		< 0.001
Male	63.2%
Female	36.8%
Race		< 0.001
White	71.0%
Black	6.0%
Hispanic	16.1%
Asian/Pacific Islander	2.0%
Native American	0.9%
Other	3.5%
Unknown	0.4%
Primary payer		< 0.001
Medicare	31.4%
Medicaid	21.4%
Private	36.6%
Self-Pay	5.6%
Income quartile by ZIP code		< 0.001
(1) Quartile 1	28.3%
(2) Quartile 2	26.9%
(3) Quartile 3	24.5%
(4) Quartile 4	19.4%
Missing	0.8%
Transfer status		< 0.001
Transferred in from acute care hospital	17.9%
Not transfer	79.3%
Weekend admission status		< 0.001
Admitted on weekend (1)	17.0%
Not admitted on weekend (0)	83.0%
Admission type		< 0.001
Emergency	46.1%
Urgent	26.8%
Elective	26.9%
Trauma center	0.1%
Hospital type		< 0.001
Teaching hospital	74.9%
Non-Teaching hospital	25.1%
Hospital bed size		< 0.001
Small	4.4%
Medium	18.0%
Large	77.6%
Hospital region		< 0.001
Northeast	17.8%
Midwest	22.7%
South	35.4%
West	24.2%
Control of hospital		< 0.001
Private, non-profit	32.8%
Private, investor owned	5.8%

¹Number of cases (weighted): 83884; Age, mean ± SD: Mean 54.2 ± 13.9.

Table 2 Diagnostic data¹

	Percent	χ2P value
Diagnosis (ICD-9 code)
Portal hypertension (572.3)	43.5%	< 0.001
Ascites (789.5)	30.9%
Esophageal variceal bleeding (456.20)	28.9%
Other ascites (789.59)	18.8%
Acute post-hemorrhagic anemia (285.1)	18.3%
Diabetes, uncomplicated (250.00)	17.8%
Hepatic encephalopathy (572.2)	17.5%
Hypertension NOS (401.9)	17.4%
Cirrhosis of liver NOS (571.5)	16.1%
Alcoholic Liver Cirrhosis (571.2)	15.3%
Thrombocytopenia NOS (287.5)	15.0%
Varices of other sites (456.8)	13.7%
Acute kidney failure NOS (584.9)	13.3%
Esophageal varices w/no bleeding (456.21)	13.1%
Acute respiratory failure (518.81)	12.8%
AHRQ comorbidity measure
AIDS	0.7%	< 0.001
CHF	5.2%	< 0.001
Coagulopathy	35.7%	< 0.001
Liver disease	84.1%	< 0.001
Lymphoma	0.6%	< 0.001
Fluid and electrolyte disorders	36.8%	< 0.001
Metastatic cancer	1.3%	< 0.001
Perivascular disease	3.7%	< 0.001
Pulmonary circulation disorders	3.2%	< 0.001
Renal failure	13.6%	< 0.001
Solid tumor without mets	3.3%	< 0.001
Valvular disease	2.4%	< 0.001
Weight loss	14.0%	< 0.001

¹Number of diagnoses, mean ± SD: Mean 10.4 ± 5.1; Number of chronic conditions, mean ± SD: Mean 6.0 ± 2.6; Number of procedures, mean ± SD: Mean 4.8 ± 3.3. AIDS: Acquired immune deficiency syndrome; CHF: Congestive heart failure; ICD: International classification of diseases; AHRQ: Agency for Healthcare Research and Quality.

Table 3 Demographic and hospital predictors of in-hospital death

	OR: Death in Hospital	95%CI: Lower	95%CI: Upper	P value
Demographic
Age (every 1 yr increase)	1.009	1.008	1.011	< 0.001
Age group (Reference: Age 50-59)
0-9	0.354	0.252	0.498	< 0.001
10-19	0.529	0.417	0.672	< 0.001
20-29	0.427	0.354	0.515	< 0.001
30-39	1.076	0.986	1.175	0.100
40-49	1.085	1.027	1.147	0.004
50-59	REF	REF	REF	REF
60-69	1.124	1.063	1.189	< 0.001
70-79	1.248	1.164	1.337	< 0.001
80-89	1.360	1.197	1.546	< 0.001
90-99	0.666	0.256	1.733	0.405
Age > 70 (Ref: Age 0-70)	1.280	1.206	1.359	< 0.001
Gender (Reference: Female)
Male	1.072	1.028	1.118	0.001
Female	REF	REF	REF	REF
Race (Reference: Caucasian)
Caucasian	REF	REF	REF	REF
Black	1.809	1.667	1.963	< 0.001
Hispanic	1.043	0.979	1.111	0.195
Asian/Pacific Islander	1.064	0.905	1.250	0.452
Native American	1.696	1.385	2.076	< 0.001
Other	1.470	1.314	1.644	< 0.001
Unknown	0.401	0.239	0.675	0.001
Primary payer (Reference: Private)
Medicare	1.140	1.085	1.199	< 0.001
Medicaid	1.113	1.052	1.177	< 0.001
Self-Pay	1.610	1.482	1.749	< 0.001
Private	REF	REF	REF	REF
Income quartile by ZIP (Reference: 1st quartile)
1st quartile	REF	REF	REF	REF
2nd quartile	0.948	1.210	2.430	0.297
3rd quartile	1.038	0.860	1.050	0.467
4th quartile	1.012	0.940	1.150	0.830
Missing income data	1.714	0.910	1.130	0.002
Transfer status (Reference: Non-transfer)
Transferred in from different acute care hospital	1.347	1.232	1.473	< 0.001
Non-transfer	REF	REF	REF	REF
Weekend admission status (Reference: Weekday)
Weekend admission	1.423	1.350	1.500	< 0.001
Weekday admission	REF	REF	REF	REF
Admission type (Reference: Elective)
Emergency	3.032	2.835	3.244	< 0.001
Urgent	2.293	2.129	2.470	< 0.001
Elective	REF	REF	REF	REF
Trauma center	4.541	2.772	7.440	< 0.001
Hospital
Teaching hospital status (Reference: Non-teaching hospital)
Teaching Hospital	1.149	1.086	1.717	< 0.001
Non-Teaching Hospital	REF	REF	REF	REF
Hospital bed size (Reference: Large)
Small	0.858	0.773	0.953	0.004
Medium	0.940	0.891	0.992	0.025
Large	REF	REF	REF	REF
Hospital region (Reference: West)
Northeast	1.449	1.365	1.538	< 0.001
Midwest	0.982	0.925	1.043	0.572
South	0.917	0.868	0.969	0.002
West	REF	REF	REF	REF
Hospital control (Reference: Private, investor owned)
Private, Non-profit	0.985	0.897	1.083	< 0.001
Private, Investor owned	REF	REF	REF	REF

Table 4 Diagnostic predictors of in-hospital death

	OR: Death in Hospital	95%CI: Lower	95%CI: Upper	P value
Number of diagnoses	1.095	1.091	1.099	< 0.000
Number of procedures	1.249	1.242	1.256	< 0.000
Diagnosis (Reference: No disease)
Portal hypertension (5723)	0.689	0.660	0.719	0.000
Ascites (7895)	1.020	0.977	1.066	0.369
Esophageal variceal bleeding (45620)	2.187	2.098	2.279	0.000
Other ascites (78959)	0.783	0.741	0.827	0.000
Acute post-hemorrhagic anemia (2851)	2.011	1.920	2.105	0.000
Diabetes, uncomplicated (25000)	0.474	0.443	0.506	0.000
Hepatic encephalopathy (5722)	2.217	2.118	2.322	0.000
Hypertension NOS (4019)	0.597	0.561	0.635	0.000
Cirrhosis of liver NOS (5715)	0.836	0.789	0.886	0.000
Alcoholic liver cirrhosis (5712)	1.079	1.021	1.141	0.007
Thrombocytopenia NOS (2875)	1.081	1.022	1.142	0.006
Varices of other sites (4568)	0.784	0.736	0.835	0.000
Acute kidney failure NOS (5849)	4.359	4.162	4.566	0.000
Esophageal varices w/no bleeding (45621)	0.445	0.411	0.481	0.000
Acute respiratory failure (51881)	8.246	7.875	8.634	0.000
AHRQ comorbidity measures (Reference: No disease)
AIDS	1.579	1.216	2.050	0.001
CHF	1.437	1.300	1.587	< 0.001
Coagulopathy	2.016	1.918	2.119	< 0.001
Liver disease	1.051	0.981	1.125	0.156
Lymphoma	1.842	1.414	2.402	< 0.001
Fluid and electrolyte disorders	2.823	2.684	2.969	< 0.001
Metastatic cancer	1.412	1.167	1.708	< 0.001
Perivascular disease	1.527	1.292	1.806	<0.001
Pulmonary circulation disorders	1.496	1.249	1.792	< 0.001
Renal failure	1.036	0.933	1.151	0.506
Solid tumor without mets	1.491	1.322	1.681	< 0.001
Valvular disease	1.067	0.910	1.252	0.424
Weight loss	1.595	1.453	1.751	< 0.001

AIDS: Acquired immune deficiency syndrome; CHF: Congestive heart failure; ICD: International classification of diseases; AHRQ: Agency for healthcare research and quality.