Sharp rise seen in acute-on-chronic liver failure incidence, costs

Last Updated: 2016-10-17

By Reuters Staff

NEW YORK (Reuters Health) - Cirrhosis and acute-on-chronic liver failure (ACLF) are on the rise in the United States, new findings show.

ACLF occurs when deterioration of liver function in cirrhosis patients leads to the failure of one or more organs. Twenty-eight day mortality in ACLF ranges from 22% to 73%, depending on how many organs fail, according to Dr. Alina Allen of the Mayo Clinic in Rochester, Minnesota and colleagues.

In the new study, published online October 3 in Hepatology, the researchers used 2001-2011 data from the Nationwide Inpatient Sample to examine trends in hospitalizations for cirrhosis and ACLF. Over the study period, annual hospitalizations for cirrhosis rose from 371,000 to 658,900. In 2001, 1.5% (n=5,407) of patients discharged for cirrhosis met ACLF criteria, compared to 5% (n=32,335) in 2011.

Length of hospital stay averaged 16 days for patients with ACLF, and 7 days for patients with cirrhosis but no ACLF.

Over the course of the study, the percentage of patients with cirrhosis due to viral or alcoholic liver disease decreased. The proportion of ACLF patients with respiratory failure or renal failure decreased, while cardiovascular failure and hepatic coma increased.

Annual costs for cirrhosis hospitalizations increased from $4.8 billion in 2001 to $9.8 billion in 2011. Costs for ACLF rose from $320 million to $1.7 billion. During the study period, the mean cost per cirrhosis hospitalization increased from $13,079 to $15,193, while for ACLF it decreased from $57,845 to $53,570. The cost per hospitalization for ACLF was 3.5 times higher than for cirrhosis in 2011.

"The increasing number of hospitalizations for multiorgan failure in cirrhosis is partly explained by the increase in infectious complications, a recognized leading cause of decompensation and death in this patient population," Dr. Allen said in a press release accompanying the study. Also, she and her colleagues note, an increasing number of Americans have hepatitis C, while people with liver disease may be living long enough to have it progress to cirrhosis and ACLF. The rise in obesity and concomitant increase in nonalcoholic fatty liver disease may also play a role, they write.

"Despite major improvements in liver disease management, the care standards seem to be far from optimal, as evident by growing rates of hospitalizations for complications of cirrhosis," Dr. Allen said in the release. "The concerning trends observed in this study will not change without systematic and coordinated attempts that target healthcare, from risk-factor modification to early diagnosis and better disease management."

Dr. Allen was not available for an interview by press time.

SOURCE: http://bit.ly/2ek9mlG

Hepatology 2016.