Retrospective Cohort Study
Copyright ©The Author(s) 2021.
World J Hepatol. Jun 27, 2021; 13(6): 686-698
Published online Jun 27, 2021. doi: 10.4254/wjh.v13.i6.686
Table 1 Characteristics of patients and hospitals and individual effects on mortality, length of stay and total charges
Study time period
1998-2017
Individual effect (Type III test, P value)
Mortality
Length of stay
Total charges
BCS patients' characteristics
Age50.50 (0.19)< 0.0010.052< 0.001
Female55.19 (0.54)0.0030.001< 0.001
Race0.1380.013< 0.001
1: White56.03 (0.54)
2: Black13.26 (0.37)
3: Hispanic9.56 (0.32)
4: Asian/Pacific Islander2.56 (0.17)
6: Other3.65 (0.2)
9: Unknown14.93 (0.39)
Primary payer< 0.0010.002< 0.001
1: Medicare33.17 (0.52)
2: Medicaid18.42 (0.42)
3: Private insurance40.20 (0.54)
6: Other8.21 (0.3)
Hospital characteristics
Hospital size0.014< 0.001< 0.001
1: Small9.81 (0.32)
2: Medium18.92 (0.43)
3: Large71.27 (0.49)
Hospital location and teaching status0.195< 0.001< 0.001
1: Rural6.89 (0.28)
2: Urban nonteaching24.24 (0.47)
3: Urban teaching68.87 (0.51)
Hospital region0.5330.010< 0.001
1: Northeast21.84 (0.45)
2: Midwest22.15 (0.46)
3: South33.45 (0.52)
4: West22.57 (0.46)
Clinical characteristics
Ascites29.93 (0.5)< 0.001< 0.001< 0.001
Acute kidney injury18.84 (0.43)< 0.001< 0.001< 0.001
Hepatic cirrhosis with no mention of alcohol18.65 (0.43)0.9010.0310.838
Cancer17.26 (0.41)< 0.0010.0020.010
Portal hypertension16.57 (0.41)0.0290.8980.000
Hepatic encephalopathy9.59 (0.32)< 0.001< 0.001< 0.001
Portal vein thrombosis7.92 (0.3)0.0060.3720.073
Esophageal varices without bleeding 7.44 (0.29)0.0020.3240.091
Acute respiratory Failure7.03 (0.28)< 0.001< 0.001< 0.001
HCC6.93 (0.28)< 0.001< 0.0010.543
Acute blood loss anemia/hemorrhagic6.62 (0.27)0.008< 0.001< 0.001
IVC thrombosis6.39 (0.27)< 0.001< 0.001< 0.001
Sepsis6.10 (0.26)< 0.001< 0.001< 0.001
Alcoholic cirrhosis5.73 (0.25)0.1130.7310.140
Acute liver failure5.60 (0.25)< 0.001< 0.001< 0.001
Hepatorenal syndrome3.29 (0.2)< 0.001< 0.001< 0.001
Variceal bleeding3.20 (0.19)0.1070.1600.001
Spontaneous bacterial peritonitis2.83 (0.18)< 0.001< 0.001< 0.001
Intestinal infarct/acute vascular insufficiency2.11 (0.16)< 0.001< 0.001< 0.001
Elixhauser Comoridity Score excluding liver disease9.38 (0.12)< 0.001< 0.001< 0.001
Table 2 Trends in outcomes of interest

1998-2017 (unweighted: 8435, weighted: 41119)
1998 (unweighted: 262, weighted: 1367)
2017 (unweighted: 680, weighted: 3400)
APC (95%CI)
P value for APC
Procedures
Number of procedures 2.64 (0.03)3.09 (0.20)2.42 (0.13)-0.51% (-1.09%, 0.06%)0.082
Paracentesis18.41 (0.42)28.56 (2.82)16.47 (1.42)-1.67% (-2.53%, -0.81%)0.000
Upper endoscopy10.94 (0.34)13.08 (2.06)11.91 (1.24)-0.17% (-1.31%, 0.97%)0.766
Liver biopsy6.24 (0.26)10.35 (1.9)5.15 (0.85)-4.01% (-5.42%, -2.58%)< 0.0001
Portosystemic shunt/TIPS3.63 (0.2)6.12 (1.54)2.94 (0.65)-4.95% (-6.78%, -3.09%)< 0.0001
Liver transplantation1.9 (0.15)1.29 (0.75)2.06 (0.54)-2.68% (-5.26%, -0.02%)0.048
Disposition of patient
1: Discharged to home or selfcare58.8(0.54)50.71 (3.12)55.96 (1.91)-0.28% (-0.77%, 0.21%)0.262
6: Home health care13.49 (0.37)12.04 (2.04)17.23 (1.45)3.31% (2.20%, 4.43%)< 0.0001
5: Transfer: other type of facility11.12 (0.34)10.21 (1.89)12.08 (1.25)1.87% (0.70%, 3.06%)0.002
20: Died in hospital8.74 (0.31)18.17 (2.44)7.66 (1.02)-4.31% (-5.50%, -3.10%)< 0.0001
2: Transfer: short-term hospital6.8 (0.28)8.25 (1.71)5.6 (0.88)-1.26% (-2.66%, 0.17%)0.084
7: Against medical advice1 (0.11)0.61 (0.43)1.47 (0.46)2.94% (-1.02%, 7.07%)0.148
Outcomes
Number of deaths737 (Unweighted); 3591 (Weighted)46 (Unweighted); 249 (Weighted)52 (Unweighted); 260 (Weighted)
Mortality rate per 1000000 United States populations0.90.8-0.29% (-0.86%, 0.27%)0.309
Mortality rate per 1000000 inpatients8.878.550.34% (-0.23%, 0.92%)0.243
Mortality rate among BCS inpatients0.090.180.08-4.41% (-4.95%, -3.88%)< 0.0001
Length of stay (d)8.84 (0.13)12.73 (1.01)7.64 (0.36)-2.04% (-2.67%, -1.41%)< 0.0001
Average total charges in 2017 dollars94440.04 (1996.06)95515.01 (9483.24)103850.98 (8183.79)1.15% (0.35%, 1.96%)0.005
Table 3 Multivariate model on mortality

Response
Beta estimate
Standard error
P value for beta
Odds ratio (95%CI)
Age0.0240.003< 0.00011.024 (1.019, 1.029)
Acute respiratory FailureYes (reference = No)1.6520.109< 0.00015.219 (4.211, 6.468)
Intestinal infarct/acute vascular insufficiencyYes (reference = No)1.4220.201< 0.00014.143 (2.795, 6.142)
Acute liver failureYes (reference = No)1.2860.119< 0.00013.617 (2.864, 4.567)
Hepatorenal syndromeYes (reference = No)1.1230.147< 0.00013.072 (2.302, 4.101)
CancerYes (reference = No)0.8820.098< 0.00012.415 (1.993, 2.927)
Acute kidney injuryYes (reference = No)0.8030.092< 0.00012.232 (1.862, 2.675)
Sepsis/severe sepsis/septic shockYes (reference = No)0.6350.122< 0.00011.886 (1.484, 2.398)
Hepatic encephalopathyYes (reference = No)0.2800.1170.0201.323 (1.052, 1.662)
Elixhauser Comorbidity Score excluding liver disease0.0260.004< 0.00011.027 (1.019, 1.034)
Table 4 Multivariate model on length of stay

Response
Beta estimate
Standard error
P value for Beta
P value for type 3 test
Primary payer1: Medicare (reference)0.000--0.022
2: Medicaid0.0530.0370.144
3: Private insurance0.0840.0300.005
Hospital bed size1: Small (reference)0.000--< 0.0001
2: Medium0.1130.0490.021
3: Large0.2930.042<.0001
Hospital location and teaching status1: Rural (reference)0.000--< 0.0001
2: Urban nonteaching0.2060.054<.0001
3: Urban teaching0.4330.050<.0001
Hospital region1: Northeast 0.1710.038<.0001< 0.0001
2: Midwest0.0170.038<.0001
3: South0.0550.034<.0001
4: West (reference)0.000
Complications
Acute liver failureYes (reference = No)0.2230.057< 0.0001< 0.0001
Acute respiratory FailureYes (reference = No)0.3800.052< 0.0001< 0.0001
Acute kidney injuryYes (reference = No)0.2550.035< 0.0001< 0.0001
AscitesYes (reference = No)0.1180.028< 0.0001< 0.0001
Spontaneous bacterial peritonitisYes (reference = No)0.4800.076< 0.0001< 0.0001
IVC thrombosisYes (reference = No)0.1380.0520.0080.008
Intestinal infarct/acute vascular insufficiencyYes (reference = No)0.3830.088< 0.0001< 0.0001
cancerYes (reference = No)-0.2780.036< 0.0001< 0.0001
Elixhauser Comorbidity Score excluding liver disease0.0190.001< 0.0001< 0.0001
Table 5 Multivariate model on total charges

Response
Estimate
Standard error
P value for beta
P value for type 3 test
Race1: White (reference)0.000--< 0.0001
2: Black-0.0370.0260.162
3: Hispanic0.0150.0310.613
4: Asian/Pacific Islander0.1360.0580.019
6: Other0.0820.0460.077
9: Unknown-0.1850.025< 0.0001
Hospital bed size1: Small (reference)0.000--< 0.0001
2: Medium0.0800.0340.018
3: Large0.1690.029< 0.0001
Hospital location and teaching status1: Rural (reference)0.000--< 0.0001
2: Urban nonteaching0.4280.037< 0.0001
3: Urban teaching0.5520.034< 0.0001
Hospital region1: Northeast-0.1950.027< 0.0001< 0.0001
2: Midwest-0.3330.027< 0.0001
3: South-0.3300.024< 0.0001
4: West (reference)0.000--
Complications
Acute liver failureYes (reference = No)0.0780.0390.0440.044
Acute respiratory FailureYes (reference = No)0.2040.036< 0.0001< 0.0001
Acute kidney injuryYes (reference = No)0.1460.025< 0.0001< 0.0001
Hepatorenal syndromeYes (reference = No)-0.1320.0500.0080.009
IVC thrombosisYes (reference = No)0.0750.0350.0350.035
Acute blood loss anemia/ hemorrhagicYes (reference = No)0.1550.035< 0.0001< 0.0001
CancerYes (reference = No)-0.0520.0250.0370.037
Elixhauser Comoridity Score excluding liver disease0.0050.001< 0.0001< 0.0001
Other variables
Number of procedures0.1180.004< 0.0001< 0.0001
Length of stay0.0540.001< 0.0001< 0.0001