The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Abstract

Objectives: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals.

Method: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009–June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk.

Results: A total of 2,542 patients hospitalized with HRS were identified (average age = 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5 days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality.

Conclusion: HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.

Keywords:

• Hepatorenal syndrome
• hospital charges
• hospital reported data
• resource utilization
• burden of illness
• electronic health record

JEL classification codes:

• I10
• I19

Transparency

Declaration of funding

This study was funded by Mallinckrodt Pharmaceuticals, Inc., Bedminster, NJ.

Declaration of financial/other relationships

KJ, XH, BL, AP, and GW have disclosed that they are current employees (KJ, XH, and GW) or former employees (BL and AP) of Mallinckrodt Pharmaceuticals, which provided research funding to Boston Strategic Partners, Inc. (BSP) for initial analysis and manuscript drafts. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We thank Drs Jeffrey R. Skaar, Corey D. Snelson, and Hussain Badani at Boston Strategic Partners (supported by Mallinckrodt Pharmaceuticals, Inc.) for providing initial analysis and drafting of this manuscript. This data has been previously presented at ISPOR 2017, AASLD 2017, and ASN 2017.

Data availability statement

The minimal data set underlying the findings in our study data is reported within this manuscript. Data is available from Cerner Corp (www.cerner.com).