Renal failure ups mortality, hospital utilization in NASH patients

The prevalence of renal failure in hospitalized nonalcoholic steatohepatitis (NASH) patients significantly increases mortality, hospital costs, and length of stay, reveals a study.

“NASH is a common medical condition associated with significant morbidity and mortality,” the authors said. “A paucity of data exists regarding the impact of kidney failure (defined as acute and chronic kidney failure) on outcomes of NASH hospitalizations.”

To address this gap, a retrospective cohort study was conducted using the 2016 Nationwide Inpatient Sample dataset of adult patients hospitalized for NASH, stratified for the presence of renal failure.

Inpatient mortality was the primary outcome, while secondary ones included length of stay and mean total hospitalization charges. Multivariate logistic regression was performed to analyse the predictors.

A total of 7,135,090 patients were identified, of which 6,855 were admitted for NASH. Of the NASH patients, 598 (8.7 percent) had comorbid kidney failure.

Multivariate regression analysis revealed that NASH patients with renal failure had increased in-hospital death (odds ratio [OR], 28.72, 95 percent confidence interval [CI], 8.99–91.73), length of stay (β, 3.02, 95 percent CI, 2.54–3.5), total hospital cost (β, $37,045, 95 percent CI, $31,756–42,335.62).

In the renal failure group, mortality was positively associated with Charlson Comorbidity Index ≥3 (adjusted OR, 3.26, 95 percent CI, 1.04–11.51), variceal bleeding (adjusted OR, 3.02, 95 percent CI, 1.06–8.61), and hepatic encephalopathy (adjusted OR, 26.38, 95 percent CI, 1.29–540.56).

On the other end, Medicaid (adjusted OR, 0.047, 95 percent CI, 0.28–0.79) and private insurance (adjusted OR, 0.56, 95 percent CI, 0.38–0.83) were associated with decreased mortality.

“As a result, clinicians should be vigilant in treating kidney failure in this population,” the authors said.