World Congress at ACG2017
Simultaneous Plenary Session 4A: Liver
53 - Toxin And Drug-Induced Hepatitis: A Nationwide Analysis of Temporal Trends, Cost of Care and Outcomes
Wednesday, October 18
8:30 AM - 8:40 AM
Location: Valencia Ballroom BC (Level 4)
Khwaja Haq, MD
Chief Medical Resident
New York Medical College at Westchester Medical Center
Valhalla, New York
Award: 2017 Fellows-in-Training Award (Liver Category)
Khwaja F. Haq, MD1, Shantanu Solanki, MD1, Priyanka Chugh, MD2, Zahava C. Farkas, DO1, Muhammad Ali Khan, MD3, Muhammad Talha Farooqui, MD4, Azam H. Burney5, Shalom Frager, MD1, Dhruv Mehta, MD1, Raja Chandra Chakinala, MD1, Lavneet Chawla, MD1, David C. Wolf, MD1
1New York Medical College at Westchester Medical Center, Valhalla, NY; 2New York Medical College at Westchester Medical Center, New York, NY; 3University of Tennessee Health Science Center, Memphis, TN; 4University of Nevada School of Medicine, Las Vegas, NV; 5Kingsbrook Jewish Medical Center, Brooklyn, NY
Introduction: Toxin and drug-induced hepatitis (TDIH) is the leading cause of acute hepatic failure in developed countries. The condition is difficult to study on account of the broad array of culprit agents, wide range of clinical presentations and lack of diagnostic tests. Limited data exists on inpatient hospitalization trends, demographic variations, cost of care, and outcomes in patients with this diagnosis.
Methods: We conducted a retrospective study using the National Inpatient Sample (NIS) database. NIS is the largest publicly available all-payer inpatient database in the United States. We identified all patients with a primary or secondary discharge diagnosis of toxic and drug-induced hepatitis (ICD-9 code 573.3) during the years 2001-2011. Statistical significance of variation for hospital discharges, patient demographics, cost of care and outcomes was determined using the Cochran-Armitage trend test.
Results: In 2001, there were 39,503 hospitalizations with a discharge diagnosis of toxic and drug-induced hepatitis as compared to 46,789 in 2011 [P < 0.0001, fig. 1A]. Women and Caucasians had the highest number of discharges [P < 0.0001]. Between 2001 and 2011, there was a decrease in the number of cases in patients age 35-49 and an increase in patients age 50-64 [P < 0.0001, fig.1B]. Patients in the South accounted for the highest percent of TDIH cases (about 41% of discharges). There was an increase in diagnoses in the West (from 17.6% to 20.2% of discharges) and a decrease in the Northeast (from 18.2% to 15.6% of discharges) [P < 0.0001, fig. 1C]. Demographic groups experiencing downward trends in discharges included patients discharged from rural hospitals, those with higher median household incomes, and patients with private health insurance [P < 0.0001, fig. 1D, 2A, B). In-hospital mortality decreased during the decade from 5.4% to 5.0% of patients with a diagnosis code of 573.3 [P < 0.0001, fig. 2C]. Mean cost of care increased from $13,366 to $15,727 [adjusted for inflation, P < 0.0001, fig. 2D].
Discussion: Our analysis of the NIS database demonstrated a dramatic increase in the number of discharges for toxin and drug-induced hepatitis between 2001 and 2011. These cases were most commonly noted in the southern US, with an increasing number of cases reported in the West. Encouragingly, in-hospital mortality is decreasing. Multicenter, regionally-based studies will be needed to better elucidate the specific agents responsible for these demographic trends.
Supported by Industry Grant: No
Citation: . TOXIN AND DRUG-INDUCED HEPATITIS: A NATIONWIDE ANALYSIS OF TEMPORAL TRENDS, COST OF CARE AND OUTCOMES. Program No. 53. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.