HBV infection is associated with greater mortality in hospitalised patients compared to HCV infection or alcoholic liver disease

Abstract

Background Little is known about outcomes of Hepatitis B virus (HBV)-related hospitalisations. Aim To compare the characteristics and outcomes of hospitalised HBV patients to those with Hepatitis C virus (HCV) infection and alcoholic liver disease (ALD), and to examine variables associated with poor outcomes. Methods Using the 2011 US Nationwide Inpatient Sample, we identified hospitalised patients with HBV, HCV or ALD-related admissions using ICD-9-CM codes. We compared liver-related complications between the three groups. Multivariable regression was performed to identify factors associated with in-hospital mortality and length of stay. Results A total of 22 843 HBV, 203 300 HCV and 244 383 ALD-related discharges were included. Cirrhosis was noted less commonly in those with HBV (69.1%) compared to HCV (83.9%) or ALD (80.9%) (P < 0.001). In contrast, hepatocellular cancer and acute liver failure were more common with HBV (16.5% and 5.2%) compared to HCV (10.4% and 2.8%) or ALD (2.5% and 4.9%) respectively (P < 0.0001). On multivariable analysis, adjusting for demographics, liver and nonliver comorbidity, HBV infection was associated with higher mortality compared to HCV infection [Odds ratio (OR) 1.21, 95% CI: 1.04-1.39) or ALD (OR: 1.21, 95% CI: 1.05-1.40). Length of hospital stay was greater with HBV compared to HCV (+0.54 days) or ALD (+0.36 days). Among those with HBV, significant factors associated with mortality included renal failure, hepatocellular cancer, respiratory failure, ascites, coagulopathy and acute liver failure. Conclusion Patients hospitalised with HBV infection represent a particularly high-risk group with poor in-hospital outcomes and increased mortality compared to HCV infection or alcoholic liver disease.