S2848 The Impact of Ischemic Hepatitis on Outcomes and Healthcare Resources Utilization in Patients With Congestive Heart Failure

Introduction: Hepatic congestion and/or liver hypoperfusion in the setting of heart failure leads to ischemic hepatitis (IH). Accordingly, evaluating the impact of ischemic hepatitis as a potential predictor of heart failure outcomes would provide a better understanding of both diseases. Methods: The National Inpatient Sample (NIS) from 2016 to 2020 was retrospectively queried using International Classification of Diseases, Tenth Revision Clinical Modification/PCS codes to identify patients discharged with a diagnosis of CHF and concomitant IH. Primary outcome was in-hospital mortality. Secondary outcomes included rate of post-procedural complications such as acute kidney injury (AKI), shock, encephalopathy, and sepsis. Length of stay (LOS), total hospital charges and hospital cost were calculated. Kaplan Mier analysis was conducted to compare survival between the 2 groups. Moreover, multivariate logistic regression analysis was performed to adjust for potential confounders. Results: A total of 1,372,419 patients were included in the analysis. Patients were categorized into 2 groups based on the presence of IH. Among these patients, 36839 (2.7%) were identified to have IH. These patients were less likely to be women (41.3% vs 47.9%; P < 0.01), and less likely to be White (63.5% vs 68%; P < 0.01). Mean age of diagnosis was lower among those with ischemic hepatitis (66.7 vs 70.5; P < 0.01) which explains the predominance of Medicare insurance in both groups (59.4% and 70.3%; P < 0.01). However, those without ischemic hepatitis had higher comorbidity rates including type 2 DM (40.2% vs 30.4%; P <0.01), CKD stage V (6.1% vs 4.5%; P < 0.01) and BMI >40 (11.2% vs 6.6%; P < 0.01). Kaplan Mier survival analysis did not show a significantly higher mortality between the 2 groups during hospitalization. Among patients with IH, predictors of mortality were SIRS (4.49; P < 0.01), sepsis (2.41; P < 0.01), AKI (3.65; P < 0.01), CKD V (1.89; P < 0.01), ascites (1.89; P < 0.01), cirrhosis (1.18; P < 0.01), age 40-64 (1.55; P < 0.01), age over 65 (2.90; P < 0.01). On multivariate analysis, there was no significant difference in in-hospital mortality (aOR 0.96; P = 0.1) or in the length of stay (5.36; P = 0.34). However, patients with IH had higher odds of ICU admissions aOR 1.42; P < 0.01), shock (aOR 1.41; P < 0.01)), AKI (aOR 1.42; P < 0.01) and pleural effusion (aOR 1.40; P < 0.01). Conclusion: Ischemic hepatitis in patients with congestive heart failure is associated with higher in-hospital complications however in-hospital mortality and length of stay were not significantly different.