Outcomes in Acute Decompensated Congestive Heart Failure Admissions with Chronic Liver Disease: A Nationwide Analysis Using the National Inpatient Sample.

Abstract

Aim: The aim of our study was primarily to analyze hospital outcomes for acute decompensated heart failure (ADHF) admissions with a comorbid diagnosis of chronic liver disease (CLD).

Methods: The NIS was used to select ADHF admissions. The population characteristics of general ADHF admissions were compared with ADHF admissions with a comorbid diagnosis of CLD. Multivariate probit logistic regression was used to analyze the association between a documented diagnosis of CLD/alcoholic liver disease and all-cause mortality in ADHF admissions. Confounders were accounted for. Propensity scoring and nearest neighbor matching were conducted to select a matched cohort with and without CLD from ADHF admissions to further look at mortality outcomes.

Results: ADHF admissions with a comorbid diagnosis of CLD had a significantly higher proportion of all-cause mortality, 0.054 (0.053-0.057), a higher length of hospital stay, 6.95 days (6.84-7.06), and a higher mean of total hospital charges, USD 88,068.1, when compared to ADHF admissions without a comorbid diagnosis of CLD: all-cause mortality, 0.045 (0.044-0.046); length of hospital stay, 6.18 days (6.13-6.23); and mean total hospital charges, USD 79,946.21. A comorbid diagnosis of CLD had a significant association with all-cause mortality in ADHF admissions: OR 1.23 (1.17-1.29) after accounting for confounders. In the propensity-matched cohorts, the cohort with a diagnosis of CLD from the ADHF admissions had a higher proportion of all-cause mortality, 0.042 (0.036-0.049), when compared to the cohort without a diagnosis of chronic liver disease, 0.027 (0.022-0.033).

Conclusions: In analyzing the mortality and healthcare utilization outcomes for ADHF admissions, the comorbid diagnosis of CLD is shown to have significantly higher all-cause mortality, higher length of hospital stay, and higher mean total charges when compared to ADHF admissions without a diagnosis of CLD. A documented diagnosis of CLD had a statistically significant association with all-cause mortality in ADHF admissions after accounting for confounding factors.