Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2019; 11(1): 74-85
Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.74
Temporal trends of cirrhosis associated conditions
Tomoki Sempokuya, Guangxiang Zhang, Kazuma Nakagawa
Tomoki Sempokuya, Guangxiang Zhang, Kazuma Nakagawa, Department of Internal Medicine, the Queen’s Medical Center, Honolulu, HI 968132, United States
Author contributions: Sempokuya T conception and designed the study, acquired data, drafted and edited this manuscript, Zhang G performed statistical analysis and interpretation of data, drafted and edited the manuscript and Nakagawa K supervised the study and edited the manuscript.
Institutional review board statement: This study utilized publicly-accessible, de-identified administrative level; aggregate data, rather than patient-specific data, approval from the institutional review board was not required to conduct the study.
Institutional animal care and use committee statement: No animal subjects were utilized in this study, so involvement was not needed.
Conflict-of-interest statement: All authors disclose no conflict of interest.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have carefully reviewed the ARRIVE guidelines, and the manuscript was prepared and edited in accordance to the ARRIVE guidelines.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tomoki Sempokuya, MD, Doctor, Department of Internal Medicine, the Queen’s Medical Center, 1356 Lusitana Street, 7th Floor, 702, Honolulu, HI 96813, United States. tsempoku@hawaii.edu
Telephone: +1-808-5862910 Fax: +1-808-5867486
Received: October 12, 2018
Peer-review started: October 15, 2018
First decision: November 1, 2018
Revised: December 29, 2015
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 27, 2019
Processing time: 107 Days and 21.9 Hours
ARTICLE HIGHLIGHTS
Research background

There is limited data on recent temporal trends of cirrhosis associated conditions in the United States, which is critical to identify problems related to hospitalizations.

Research motivation

Healthcare cost reduction, especially in the United States, is a current focus on providing cost-effective care. Recognizing problems in temporal trends enables to create action plan to reduce unnecessary costs.

Research objectives

We aim to conduct a descriptive study to identify 10-year temporal trends of cirrhosis associated conditions which can guide future prospective studies.

Research methods

We used publicly available National Inpatient Sample to conduct 10-year trends analysis of cirrhosis associated conditions identified by ICD-9 codes from 2005 to 2014. Simple linear regression and multiple regression models were utilized for statistical analysis.

Research results

The total number of discharges of Hepatic encephalopathy/coma (HC), Spontaneous bacteria peritonitis (SBP) and esophageal varices with bleeding (EV) had significant increase. Notably, HC associated with viral hepatitis showed faster rate of increase of hospitalizations. Mortalities has decreased for HC, SBP and transjugular intrahepatic portosystemic shunt (TIPS), but no change was observed for EV. Aggregate cost of hospitalizations for HC, EV and SBP had significant increase after adjustment for inflation; however TIPS showed non-significant trends toward decreasing cost.

Research conclusions

The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. Especially, HC related to viral hepatitis showed fast rate of increase which suggest appropriate treatment of viral hepatitis maybe necessary to reduce HC in these population. In addition, the inpatient mortality rates for most of these conditions decreased.

Research perspectives

Viral hepatitis related cirrhosis maybe contributing to high cost of hospitalization especially hospitalization related to HC. These findings suggest necessity of studies beyond 2014 after introduction of newer antiviral agents for hepatitis C as well as studies to identify trends of re-admission and post-hospitalization mortality.