Affiliation:
1. Department of Gastroenterology and Hepatology Cleveland Clinic Cleveland Ohio USA
2. Department of Psychiatry and Psychology Cleveland Clinic Cleveland Ohio USA
3. Department of Psychiatry University Hospitals Cleveland Medical Center Cleveland Ohio USA
4. Center for Populations Health Research Cleveland Clinic Cleveland Ohio USA
5. Department of Psychiatry Yale University School of Medicine New Haven Connecticut USA
6. Cleveland Clinic Lerner College of Medicine Cleveland Clinic Cleveland Ohio USA
7. Inflammation and Immunity Cleveland Clinic Cleveland Ohio USA
8. Pulmonary Medicine Cleveland Clinic Cleveland Ohio USA
Abstract
AbstractBackgroundHospitalization and mortality in patients with alcohol‐associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH.MethodsTemporal trends (2016–2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year.ResultsThere were 466,014,370 ED visits during 2016–2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45–64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25–44 years (from 38.5% to 42.9%). The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH.ConclusionsTemporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH.
Funder
National Institutes of Health