Clinical determinants of hospital mortality in liver failure: a comprehensive analysis of 62,717 patients

Abstract

Background Liver failure (LF) is characterised by a loss of the synthetic and metabolic liver function and is associated with a high mortality. Large-scale data on recent developments and hospital mortality of LF in Germany are missing. A systematic analysis and careful interpretation of these datasets could help to optimise outcomes of LF.

Methods We used standardised hospital discharge data of the Federal Statistical Office to evaluate current trends, hospital mortality and factors associated with an unfavourable course of LF in Germany between 2010 and 2019.

Results A total of 62,717 hospitalised LF cases were identified. Annual LF frequency decreased from 6716 (2010) to 5855 (2019) cases and was higher among males (60.51%). Hospital mortality was 38.08% and significantly declined over the observation period. Mortality significantly correlated with patients’ age and was highest among individuals with (sub)acute LF (47.5%). Multivariate regression analyses revealed pulmonary (OR_ARDS: 2.76, OR_{mechanical ventilation}: 6.46) and renal complications (OR_{acute kidney failure}: 2.04, OR_{hepatorenal syndrome}: 2.92) and sepsis (OR: 1.92) as factors for increased mortality. Liver transplantation reduced mortality in patients with (sub)acute LF. Hospital mortality significantly decreased with the annual LF case volume and ranged from 47.46% to 29.87% in low- or high-case-volume hospitals, respectively.

Conclusions Although incidence rates and hospital mortality of LF in Germany have constantly decreased, hospital mortality has remained at a very high level. We identified a number of variables associated with increased mortality that could help to improve framework conditions for the treatment of LF in the future.

Graphical Abstract

Zusammenfassung

Hintergrund Das Leberversagen (LV) ist durch einen Verlust der synthetischen und metabolischen Leberfunktion gekennzeichnet und mit einer hohen Mortalität verbunden. Zentrumsübergreifende Daten zu aktuellen Entwicklungen und Krankenhaussterblichkeit des LV in Deutschland fehlen. Eine systematische Analyse und sorgfältige Interpretation dieser Daten könnte dabei helfen, das Outcome des LV zu verbessern.

Methoden Standardisierte Krankenhausentlassungsdaten des Statistischen Bundesamtes wurden verwendet, um aktuelle Trends, die Krankenhausmortalität sowie Faktoren, die mit einem ungünstigen klinischen Verlauf des LV in Deutschland zwischen 2010 und 2019 assoziiert sind, zu analysieren.

Ergebnisse Insgesamt wurden 62.717 hospitalisierte LV-Fälle identifiziert. Die jährliche Inzidenz des LV sank von 6.716 (2010) auf 5.855 (2019) Fälle und war bei Männern höher (60,51%). Die Krankenhausmortalität betrug 38,08% und reduzierte sich im Beobachtungszeitraum deutlich (2010: 39,5%, 2019: 34,9%). Die Krankenhaussterblichkeit korrelierte signifikant mit dem Patientenalter und war bei Patienten mit (sub)akutem LV am höchsten (47,5%). Multivariate Regressionsanalysen identifizierten pulmonale (OR_ARDS: 2,76, OR_{mechanische Beatmung}: 6,46) und renale Komplikationen (OR_{akutes Nierenversagen}: 2,04, OR_{hepatorenales Syndrom}: 2,92) sowie die Sepsis (OR: 1,92) als Schlüsselfaktoren einer erhöhten Mortalität. Eine Lebertransplantation senkte die Krankenhaussterblichkeit insbesondere bei Patienten mit (sub)akutem LV. Die Krankenhaussterblichkeit nahm signifikant mit dem jährlichen LV-Fallvolumen einzelner Krankenhäuser ab und reichte von 47,46% bis 29,87% in Krankenhäusern mit niedrigem bzw. hohem Fallvolumen.

Schlussfolgerungen Obwohl die Inzidenz und Krankenhausmortalität des LV in Deutschland kontinuierlich sank, verblieb die Krankenhaussterblichkeit auf einem sehr hohen Niveau. Wir identifizierten verschiedene Variablen, die mit einer erhöhten Sterblichkeit assoziiert sind und die zukünftig dazu beitragen könnten, die Rahmenbedingungen für die Behandlung des LV zu verbessern.

Keywords

ACLF - ALF - liver transplantation - DRG - ICD-10

Schlüsselwörter

ACLF - ALF - Lebertransplantation - DRG - ICD-10

Publikationsverlauf

Eingereicht: 29. Juli 2022

Angenommen nach Revision: 16. Januar 2023

Artikel online veröffentlicht:
27. März 2023

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