Lee EW, Kuei A, Saab S, Busuttil RW, Durazo F, Han SH, El-Kabany MM, McWilliams JP, Kee ST. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2016; 22(25): 5780-5789 [PMID: 27433091 DOI: 10.3748/wjg.v22.i25.5780]
Corresponding Author of This Article
Edward W Lee, MD, PhD, Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, United States. edwardlee@mednet.ucla.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Jul 7, 2016; 22(25): 5780-5789 Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5780
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%
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
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
Citation: Lee EW, Kuei A, Saab S, Busuttil RW, Durazo F, Han SH, El-Kabany MM, McWilliams JP, Kee ST. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2016; 22(25): 5780-5789