Epidemiology and Outcomes of Hospitalizations Due to Hepatocellular Carcinoma

Sanjana Mullangi; Praneeth R Keesari; Anas Zaher; Yashwitha Sai Pulakurthi; Frank Adusei Poku; Arathi Rajeev; Prasanna Lakshmi Vidiyala; Asha Latha Guntupalli; Maheshkumar Desai; Jessica Ohemeng-Dapaah; Yaw Asare; Achint A Patel; Manidhar Lekkala

doi:10.7759/cureus.20089

Epidemiology and Outcomes of Hospitalizations Due to Hepatocellular Carcinoma

Cureus. 2021 Dec 1;13(12):e20089. doi: 10.7759/cureus.20089. eCollection 2021 Dec.

Affiliations

¹ Internal Medicine, Hillcrest Medical Center, Tulsa, USA.
² Internal Medicine, Kamineni Academy of Medical Sciences and Research Center, Hyderabad, IND.
³ Internal Medicine, University of Debrecen, Debrecen, HUN.
⁴ Internal Medicine, University of Central Oklahoma, Edmond, USA.
⁵ Internal Medicine, Government Medical College Kozhikode, Kozhikode, IND.
⁶ Internal Medicine, New Vision University, Tbilisi, GEO.
⁷ Internal Medicine, NRI Medical College and General Hospital, Chinna Kakani, IND.
⁸ Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Dalton, USA.
⁹ Internal Medicine, Trust Hospital, Accra, GHA.
¹⁰ Epidemiology and Public Health, School of Public Health, University of Ghana, Accra, GHA.
¹¹ Internal Medicine, Oak Hill Hospital, Brooksville, USA.
¹² Oncology, University of Kansas Medical Center, Kansas City, USA.

Abstract

Background Hepatocellular Carcinoma (HCC) is a severe complication of cirrhosis and the incidence of HCC has been increasing in the United States (US). We aim to describe the trends, characteristics, and outcomes of hospitalizations due to HCC across the last decade. Methods We derived a study cohort from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult hospitalizations due to HCC were identified using the International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). Comorbidities were also identified by ICD-9/10-CM codes and Elixhauser Comorbidity Software (Agency for Healthcare Research and Quality, Rockville, Maryland, US). Our primary outcomes were in-hospital mortality and discharge to the facility. We then utilized the Cochran-Armitage trend test and multivariable survey logistic regression models to analyze the trends, outcomes, and predictors. Results A total of 155,436 adult hospitalizations occurred due to HCC from 2008-2017. The number of hospitalizations with HCC decreased from 16,754 in 2008 to 14,715 in 2017. Additionally, trends of in-hospital mortality declined over the study period but discharge to facilities remained stable. Furthermore, in multivariable regression analysis, predictors of increased mortality in HCC patients were advanced age (OR 1.1; 95%CI 1.0-1.2; p< 0.0001), African American (OR 1.3; 95%CI 1.1-1.4;p< 0.001), Rural/ non-teaching hospitals (OR 2.7; 95%CI 2.4-3.3; p< 0.001), uninsured (OR 1.9; CI 1.6-2.2; p< 0.0001) and complications like septicemia and pneumonia as well as comorbidities such as hypertension, diabetes mellitus, and renal failure. We observed similar trends in discharge to facilities. Conclusions In this nationally representative study, we observed a decrease in hospitalizations of patients with HCC along with in-hospital mortality; however, discharge to facilities remained stable over the last decade. We also identified multiple predictors significantly associated with increased mortality, some of which are potentially modifiable and can be points of interest for future studies.

Keywords: hepatocellular carcinoma; hepatocellular carcinoma (hcc); in-hospital mortality; outcome; trends.