S2444 Medication Noncompliance in Hepatic Encephalopathy: Insights and Outcomes From a Nationwide Inpatient Sample

Introduction: Medication noncompliance is frequently documented in patients hospitalized with hepatic encephalopathy (HE), yet factors contributing to and outcomes associated with this phenomenon remain poorly characterized. This study aims to identify patient characteristics and clinical outcomes associated with documented medication noncompliance among patients hospitalized for HE. Methods: We conducted a retrospective cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2022, identifying patients primarily admitted with HE, and stratifying them by documented medication noncompliance status. Univariable and multivariable regression models were used to assess factors associated with medication noncompliance and examined its association with clinical and healthcare utilization outcomes. Results: Of 250,755 hospitalizations for HE, medication noncompliance was documented in 44,685 cases (17.8%). Patients with documented noncompliance were younger (mean age 59.8 vs 62.0 years, P < 0.001), more likely to be of non-White race (OR 1.26, 95% CI 1.20 – 1.36, P < 0.001), have non-private insurance (OR 1.28, 95% CI 1.20 – 1.36, P < 0.001), substance use disorders (OR 1.59, 95% CI 1.51 – 1.66, P < 0.001), hepatitis C virus infection (OR 1.59, 95% CI 1.51-1.68, P < 0.001), mental health diagnoses (OR 1.13, 95% CI 1.07-1.19, P < 0.001), and housing insecurity (OR 3.17, 95% CI 2.74-3.68, P < 0.001). Documented medication noncompliance was also associated with higher rates of discharge against medical advice (aOR 1.48, 95% CI 0.52-0.68, P < 0.001), but lower rates of mechanical ventilation (aOR 0.60, 95% CI 0.52-0.68, P < 0.001), death (aOR 0.35, 95% CI 0.29-0.42, P < 0.001), shorter hospital stays (mean 4.3 vs 5.2 days, adjusted rate ratio 0.82, P < 0.001) and lower hospitalization costs ($9,468 vs $13,885, adjusted rate ratio 0.70, P < 0.001). Conclusion: Documented medication noncompliance among patients hospitalized with HE was significantly associated with younger age, socioeconomic disparities, substance use, and mental health conditions. Additionally, medication noncompliance was linked to increased rates of discharge against medical advice, yet somewhat surprisingly, shorter hospital stays, reduced use of mechanical ventilation, decreased mortality rates, and lower hospitalization costs. Further research is warranted to clarify documentation practices and address the underlying factors influencing medication adherence, which may help prevent liver disease progression.