Clinical Characteristics and Outcomes of Decompensated Cirrhosis Patients Admitted to Hospitals With Acute Pulmonary Embolisms: A Nationwide Analysis

Mohammad Darweesh; Mahmoud M Mansour; Metri Haddaden; Rami Dalbah; Ratib Mahfouz; Hisham Laswi; Adham E Obeidat

doi:10.7759/cureus.24162

Clinical Characteristics and Outcomes of Decompensated Cirrhosis Patients Admitted to Hospitals With Acute Pulmonary Embolisms: A Nationwide Analysis

Cureus. 2022 Apr 15;14(4):e24162. doi: 10.7759/cureus.24162. eCollection 2022 Apr.

Authors

Mohammad Darweesh¹, Mahmoud M Mansour², Metri Haddaden³, Rami Dalbah¹, Ratib Mahfouz⁴, Hisham Laswi⁵, Adham E Obeidat⁶

Affiliations

¹ Internal Medicine, East Tennessee State University, Johnson City, USA.
² Internal Medicine, University of Missouri School of Medicine, Columbia, USA.
³ Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA.
⁴ Internal Medicine, Kent Hospital/Brown University, Warwick, USA.
⁵ Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.
⁶ Internal Medicine, University of Hawaii, Honolulu, USA.

Abstract

Introduction: Cirrhosis is a significant cause of mortality and morbidity worldwide. Recent studies suggested that cirrhosis is associated with an increased risk of venous thromboembolism (VTE), which disproves the old belief that chronic liver disease coagulopathy is considered protective against VTE. We conducted a retrospective study which is to our knowledge the first of its kind to assess clinical characteristics and outcomes of decompensated cirrhosis (DC) patients admitted with acute pulmonary embolism (APE).

Methodology: We used the National Inpatient Sample database for the years 2016-2019. All adults admitted to the hospitals with a primary diagnosis of APE were included. Patients less than 18 years old, missing race, gender, or age were excluded. Patients were divided into two groups, either having DC or not. A multivariate logistic regression model was built by using only variables associated with the outcome of interest on univariable regression analysis at P < 0.05.

Results: 142 million discharges were included in the NIS database between the years 2016 and 2019, of which 1,294,039 met the study inclusion criteria, 6,200 patients (0.5%) had DC. For adult patients admitted to the hospitals with APE, odds of inpatient all-cause mortality were higher in the DC group than in patients without DC; OR of 1.996 (95% CI, 1.691-2.356, P-value < 0.000). Also, vasopressor use, mechanical ventilation, and cardiac arrest were more likely to occur in the DC group, OR of 1.506 (95% CI, 1.254-1.809, P-value < 0.000), OR of 1.479 (95% CI, 1.026-2.132, P-value 0.036), OR of 1.362 (95% CI, 1.050-1.767, P-value 0.020), respectively. In addition, DC patients tend to have higher total hospital charges and longer hospital length of stay, coefficient of 14521 (95% CI, 6752-22289, P-value < 0.000), and a coefficient of 1.399 (95% CI, 0.848-1.950, P-value < 0.000), respectively.

Conclusion: This study demonstrates that DC is a powerful predictor of worse hospital outcomes in patients admitted with APE. An imbalance between clotting factors and natural anticoagulants produced by the liver is believed to be the primary etiology of thrombosis in patients with DC. The burden of APE can be much more catastrophic in cirrhotic than in non-cirrhotic patients; therefore, those patients require closer monitoring and more aggressive treatment.

Keywords: acute pulmonary embolism; decompensated cirrhosis; decompensated liver cirrhosis; live cirrhosis; pulmonary embolism (pe).