Cirrhosis as a Risk Factor for Sepsis and Death: Analysis of the National Hospital Discharge Survey

doi:10.1378/chest.124.3.1016

Chest

Volume 124, Issue 3, September 2003, Pages 1016-1020

https://doi.org/10.1378/chest.124.3.1016 Get rights and content

Study objectives:

The unfavorable influence of cirrhosis on survival in the critically ill has been supported by several single-center reports. Variations in case mix, the technological capabilities of individual facilities, and differences in organizational staffing and structure could limit the extrapolation and generalization of these data to other institutions. To assess the impact of a diagnosis of cirrhosis on outcomes of sepsis, sepsis-related mortality, and respiratory failure in hospitalized patients, we analyzed data from the National Hospital Discharge Survey (NHDS) from 1995 to 1999 to determine its national consequence.

Design:

Secondary analysis of an existing national database.

Patients or participants:

Based on NHDS estimates, 175 million hospital discharges occurred during the 5-year period of study. One percent (1.7 million) of these hospitalizations involved a diagnosis of cirrhosis.

Interventions:

None.

Measurements and results:

After adjustments for age, race, and gender, cirrhotic individuals are significantly more likely to die while hospitalized (adjusted risk ratio [RR], 2.7; 95% confidence interval [CI], 2.3 to 3.1), to have hospitalizations associated with sepsis (adjusted RR, 2.6; 95% CI, 1.9 to 3.3), and to die from sepsis (adjusted RR, 2.0; 95% CI, 1.3 to 2.6). Additionally, cirrhosis is associated with an increased RR for acute respiratory failure (adjusted RR, 1.4; 95% CI, 1.1 to 1.8) and death from acute respiratory failure (adjusted RR, 2.6; 95% CI, 1.5 to 3.6).

Conclusions:

In this national database of hospital discharge information, a diagnosis of cirrhosis is strongly associated with an increased risk of sepsis, acute respiratory failure, sepsis-related mortality, and acute respiratory failure-related mortality.

Section snippets

Survey Design

The NHDS is an annual survey conducted by the National Center for Health Statistics. Published continually since 1965, the NHDS collects medical information from a 1% sample of hospital discharge records from non-Federal, short-stay hospitals in the 50 states and the District of Columbia. General medical or surgical hospitals with average stays for all patients of < 30 days and hospitals with six or more beds for patient use are eligible. Military, Federal, Veterans Administration hospitals,

Results

The NHDS estimated that there was a total of 175 million hospital discharges nationally during the period 1995 to 1999. Of those hospital discharges, 1.7 million (1%) were associated with a diagnosis of cirrhosis. In the cirrhosis subset, 97% of the hospital discharges were identified by the ICD9-CM code for cirrhosis and 3% were coded for portal hypertension alone. In the final analysis, the patients with cirrhosis were primarily white (79%) and male (59%), with a mean (± SD) age of 56 ± 17

Discussion

With the novel application of an existing national database to analyze critical care outcomes, we have documented the substantial negative impact of a diagnosis of cirrhosis on the risk of sepsis, acute respiratory failure, and death during hospitalization. Hospitalized patients with cirrhosis are nearly three times more likely to die when compared to patients without a diagnosis of cirrhosis. Cirrhotic patients are more likely to have a concurrent diagnosis of Gram-positive or Gram-negative

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).

This research was supported by the National Institute on Alcohol Abuse and Alcoholism (grant R21 AA12779-02).

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Chest

Clinical Investigations in Critical CareCirrhosis as a Risk Factor for Sepsis and Death: Analysis of the National Hospital Discharge Survey

Study objectives:

Design:

Patients or participants:

Interventions:

Measurements and results:

Conclusions:

Section snippets

Survey Design

Results

Discussion

Chest

J Hepatol

Am J Gastroenterol

Infect Dis Clin North Am

Chest

Chest

Liver cirrhosis mortality in the United States, 1970 – 97.

Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit

Crit Care Med

Clinical Investigations in Critical Care
Cirrhosis as a Risk Factor for Sepsis and Death: Analysis of the National Hospital Discharge Survey