S2889 The Deadly Consequence of In-Hospital Infections in Acute and Subacute Liver Failure: A National Inpatient Sample Study (2016-2022)

Introduction: Acute and subacute liver failure (ALF and SLF) are severe conditions characterized by rapid deterioration of liver function and are often accompanied by infections. However, the specific impact of infections on in-hospital outcomes in ALF and SLF patients remains underexplored. We evaluated the influence of infections on in-hospital outcomes in ALF and SLF patients using the National Inpatient Sample (NIS) database. Methods: A retrospective study of the NIS database was performed using International Classification of Diseases, Tenth Revision Clinical Modification codes to identify hospitalizations for ALF and SLF. Hospitalizations were stratified by the presence or absence of infection. Weighted univariate Chi-square tests and t-tests were used to compare baseline characteristics and outcomes. Multivariable survey logistic and linear regression were used to evaluate the association between infection and in-hospital outcomes. All models were adjusted for potential confounders including demographics and comorbidities. Results: There were 179,000 ALF and SLF hospitalizations, out of which 43,000 (24%) were associated with infection. Infections were more prevalent in women (58.41% with infections vs 43.55% without; P < 0.0001), patients over 70 years (24.42% vs 21.12%; P < 0.0001), those with congestive heart failure (15.96% vs 12.61%; P < 0.0001) and those with chronic liver disease (13.27% vs 11.71%; P = 0.0001). Infected patients had increased in-hospital mortality (18.64% vs 7.49%, adjusted odds ratio (aOR) 2.89; 95% confidence interval, CI 2.66-3.13; P < 0.0001), longer length of stay (LOS) by 3.95 days (95% CI 3.60-4.30; P < 0.0001), and higher total hospital charges by $72,991 (95% CI $64,567-$81,415; P < 0.0001). Infected patients also experienced significantly higher rates of complications including acute kidney injury (54.8% vs 36.9%), encephalopathy (22.2% vs 12.2%), mechanical ventilation requirement (19.6% vs 6.0%), arrhythmia (16.5% vs 13.0%), hepatorenal syndrome (14.9% vs 8.5%), and GI bleeding (10.6% vs 6.5%) (all P < 0.0001). Conclusion: Our study demonstrates that infection is a strong negative prognostic indicator in patients hospitalized with ALF and SLF, independently associated with significantly worse in-hospital outcomes. Early recognition and targeted antimicrobial management of infections are essential to improving prognosis. Further prospective studies are needed to evaluate whether timely antimicrobial interventions and preventive strategies can reduce morbidity and mortality in ALF and SLF patients.