Chronic Liver Disease Plus Influenza Linked to Increased Inpatient Burden

Sheena Mago, DO

According to results presented at the annual American College of Gastroenterology (ACG) 2020 conference, patients with chronic liver disease admitted for influenza tended to have higher hospitalization costs, a longer length of stay, and increased disease severity. However, there was no noticeable increased risk in mortality for these patients.

Although prior small-scale studies have shown an increased risk of hepatic decompensation and hospitalization among those with cirrhosis, there has been limited data that addresses the impact of influenza among patients with other types of chronic liver diseases.

To address this shortcoming, Sheena Mago, DO, of University of Connecticut Health Center, and colleagues conducted a retrospective cohort study using data from the 2010-2014 Nationwide Inpatient Sample.

Using ICD-9 codes, they identified adults ≥18 years hospitalized with influenza. Patients with chronic liver diseases were further stratified according to specific diagnosis, which included alcoholic cirrhosis, non-alcoholic cirrhosis, alcoholic fatty liver, non-alcoholic fatty liver disease, biliary cirrhosis, and autoimmune hepatitis.

All diagnosis categories were compared with one another as well as with those with no history of chronic liver disease.

Thus, the investigators found that a total of 30,268 patients were admitted to the hospital for influenza. Of the total, 1.7% of patients were diagnosed with chronic liver disease.

The majority of chronic liver disease patients had non-alcoholic fatty liver disease (n = 236), followed by non-alcoholic cirrhosis (n = 171).

Mago and team showed that patients with chronic liver disease had increased risk of disease severity (OR, 2.66; 95% CI, 2.26-3.13; P<.001).

These patients also trended towards a longer length of hospital stay (OR, 1.07; 95% CI, 1.01-1.15; P = .031) as well as a higher hospitalization cost (OR, 1.24; 95% CI, 1.15-1.33; P<.001).

The investigators also noted that alcoholic fatty liver (OR, 39.26; 95% CI, 1.78-428.46, P = .003) and alcoholic cirrhosis (OR, 4.54; 95% CI, 1.23-13.49; P = .011) were both associated with increased odds of mortality.

However, despite the findings, there was no overall increased risk in mortality chronic liver disease (OR, 1.38; 95% CI, 0.68-2.51; P = .314).

According to the team, limitations of the study included analysis of only hospitalized patients, reliance on ICD coding, and a lack of vaccination data.

They nonetheless stressed the importance of their findings.

“The increased risk of disease severity, hospital charges, and length of stay amongst even a small subset of chronic liver disease patients highlights the importance of yearly influenza vaccinations in this population,” they wrote.

The study, “Impact of Influenza in Patients with Chronic Liver Disease: A National Inpatient Analysis,” was published online by ACG.