New Research Reveals Underestimation of Overt Hepatic Encephalopathy Hospitalizations in US

Relying solely on a primary diagnosis for overt hepatic encephalopathy (OHE) significantly underestimates the actual rate, length of stay (LOS), and costs of OHE hospitalizations, according to findings of a new study that investigated data on hospital-administered medications as an additional means to identify OHE cases.

Data from the study abstract was presented at the American Association for the Study of Liver Diseases’ annual scientific conference, The Liver Meeting 2023, held November 10-14, in Boston, MA.

“[OHE] is a serious neurological disorder, and OHE hospitalizations are burdensome for patients, caregivers, and the healthcare system,” wrote presenting author Arun Jesudian, MD, Center for Liver Disease and Transplantation, Weill Cornell Medicine, and colleagues. “The absence of an OHE-specific diagnosis (dx) code,” in a patient’s medical record, however, “may lead to an underestimation of the burden of OHE hospitalizations.”

Investigators used diagnosis codes and hospital-administered medications to identify OHE hospitalizations in the US among insured adults. They identified OHE hospitalizations using the PINC AI™ Healthcare Database (2015-2022) and excluded those with a diagnosis for other conditions with rifaximin indications (ie, traveler’s diarrhea/irritable bowel syndrome with diarrhea), according to the study abstract.

OHE hospitalizations were defined as either OHE as a primary diagnosis (definition 1) or in-hospital rifaximin/lactulose use combined with a diagnosis for altered mental status, unspecified encephalopathy, or cirrhosis (definition 2).

Researchers analyzed hospitalization characteristics (eg, treatments, diagnoses), hospital characteristics (eg, urban/rural, bed size), and outcomes (eg, billing charge, LOS) separately for the 2 OHE definitions and for Medicare and commercially insured patients.

FINDINGS

Jesudian and colleagues identified 33 127 OHE hospitalizations based on definition 1 and 99 217 additional hospitalizations based on definition 2 during the 7-year study period, according to the abstract.

The research team observed that OHE hospitalizations based on definition 1 had a mean hospital billing charge of $56 648, a mean LOS of 5.2 days, and most patients received in-hospital lactulose (91.9%; average time to first dose: 0.2 days) and/or rifaximin (61.9%; average time to first dose: 0.7 days).

Findings showed that OHE hospitalizations based on definition 2 had a mean hospital billing charge 2.5-times higher ($139 870) and a mean LOS 2-times longer (10.4 days) than those based on definition 1. Furthermore, the majority of patients received in-hospital lactulose (96.4%; average time to first dose: 1.9 days) and/or rifaximin (55.3%; average time to first dose: 2.6 days).

“OHE hospitalizations, irrespective of definition 1 or 2, had similar rates of OHE-related medication administration, comorbidities, and hospital characteristics. Results were consistent irrespective of insurance type,” stated investigators in the abstract.

Source: Systematic undercounting of overt hepatic encephalopathy hospitalizations identified by using hospital-administered medication data. Abstract presented at The Liver Meeting 2023; November 10-14, 2023; Boston, MA.