S2823 Impact of Chronic Obstructive Pulmonary Disease on In-Hospital Mortality and Resource Utilization in Patients With Hepatopulmonary Syndrome: A Nationwide Inpatient Sample Analysis

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive obstructive lung condition primarily associated with long-term smoking, while hepatopulmonary syndrome (HPS) is a complication of hepatic cirrhosis characterized by arterial hypoxemia due to intrapulmonary vascular dilatation. The coexistence of COPD and HPS presents diagnostic challenges and is associated with uncertain clinical outcomes. Given the limited research on this unique population, we conducted a nationwide study to evaluate demographic characteristics, in-hospital mortality, and resource utilization. Methods: We queried the 2018–2021 National Inpatient Sample (NIS) database to identify patients diagnosed with COPD, HPS, or both, using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. A univariate analysis followed by multivariate logistic regression was performed to adjust for potential hospital- and patient-level confounders. All statistical analyses were conducted using Stata 18.0. Results: A total of 2,675 patients with HPS were identified, of whom 555 (20.7%) also had COPD. Among those with both conditions, 47% were woman, with a mean age of 61 years. The average length of stay was 10 days, with a mean hospitalization cost of $116,344. On multivariate analysis, COPD in HPS patients was associated with significantly higher odds of in-hospital mortality (OR 3.2, 95% CI 1.8–5.9; P < 0.001). Comorbid congestive heart failure (CHF) (OR 1.69, 95% CI 1.64–1.73; P < 0.001) and end-stage renal disease (ESRD) (OR 1.57, 95% CI 1.50–1.65; P < 0.001) were also associated with increased mortality. Conversely, diabetes mellitus (DM) (OR 0.85, 95% CI 0.83–0.88; P < 0.001) and hypertension (HTN) (OR 0.91, 95% CI 0.89–0.93; P < 0.001) appeared to have protective associations. Conclusion: Hepatopulmonary syndrome is a rare but serious condition that qualifies for MELD exception in liver transplant prioritization. Our study found that nearly one in 5 patients with HPS also had COPD, and that this subgroup experienced significantly higher in-hospital mortality and healthcare costs. The average cost of $116,344 and 10-day hospital stay highlight the resource burden of this population. Comorbid CHF and ESRD further exacerbated mortality risk, underscoring the complexity of managing these patients. These findings suggest a need for heightened clinical awareness, better risk stratification, and further research into optimal management strategies for patients with coexisting COPD and HPS.