S2576 Predictors, Prevalence, and Impact of Aspiration Pneumonia in Hospitalized Patients With Hepatic Encephalopathy

Introduction: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome arising from liver dysfunction. Aspiration pneumonia (AP) is a serious complication in these high-risk patients. HE and AP share a bidirectional relationship: severe HE increases aspiration risk, while AP-induced inflammation worsens hyperammonemia and accelerates HE progression. Current AASLD and AGA guidelines highlight early airway protection and infection control as key strategies to prevent AP and reduce HE recurrence. Despite its clinical significance, the predictors, prevalence, and outcomes of AP in hospitalized HE patients remain underexplored in large NIS cohorts. Methods: We used 2019–2021 National Inpatient Sample data to identify adult hepatic encephalopathy admissions and assess AP outcomes using adjusted multivariable logistic and linear regressions. Significance was set at P < 0.05. Results: Among ∼500,000 weighted HE hospitalizations, AP prevalence was 4.7–5.0%. Men had higher AP rates than women (5.4% vs 3.9%; P < 0.001). Medicaid (5.2%) and no-charge (6.2%) patients showed higher prevalence (P = 0.0013). Urban and teaching hospitals had higher AP rates (P = 0.0008), with the Northeast and West regions showing the highest (P < 0.001). In regression models, mechanical ventilation (OR 7.62), septic shock (OR 2.26), hepatic coma (OR 1.78), and malnutrition (OR 1.51) were the strongest predictors of AP (P < 0.001). Dialysis (OR 0.90), ascites (OR 0.83), and spontaneous bacterial peritonitis (OR 0.62) were associated with reduced AP odds. AP was associated with lower adjusted mortality (aOR 0.885; P = 0.009) but significantly increased hospital charges (∼33% increase; P < 0.001) and LOS (∼39% increase; P < 0.001). Conclusion: We highlighted key clinical factors that put hospitalized HE patients at high risk for AP. Acute illness severity—especially the need for mechanical ventilation, presence of septic shock, and altered mental status—stood out as the main driver of risk, with malnutrition and overall comorbidity also contributing. We also found striking differences across patient groups and regions, reflecting real-world variation in how care is delivered. These insights highlight clear priorities: identify high-risk HE patients early, implement simple but effective preventive steps (like head-of-bed elevation, oral care, and swallow precautions). This study provides a foundation to improve outcomes and guide future quality initiatives in this population.