North Shore Medical Center Langhorne, PA, United States
Shivani Dalal, MD1, Kirtenkumar Patel, MD2, Himanshu Kavani, MD1, Krunalkumar Patel, MD1, Nishi Patel, PharmD3, Nikita Amin, RN1, Umang Patel, DO1 1St. Mary Medical Center, Langhorne, PA; 2North Shore Medical Center, Manhasset, NY; 3South University, Columbia, SC
Introduction: Hereditary hemochromatosis (HH) is a genetically mediated disorder characterized by excessive gastrointestinal absorption and accumulation of iron resulting in tissue damage. Liver being the prime organ for iron storage is the major site of tissue damage in HH. Increased iron stores in the liver can stimulate carcinogenesis. Liver damage caused by HH can range from hepatomegaly, cirrhosis, and hepatocellular carcinoma. Through this study, we aim to assess the prevalence and outcomes of hospitalized patients with HH with and without Liver Cancer (LC).
Methods: We utilized the National Inpatient Sample database from Jan 2016 - Dec 2018 using ICD10 codes for HH and LC. We have used LC as an umbrella term for various primary liver malignancies such as hepatocellular carcinoma, hepatoblastoma, angiosarcoma of the liver, primary malignancy of the liver, and intrahepatic bile duct carcinoma. Patients were divided into 2 groups: HH with and without LC. Propensity-score matching of baseline characteristics and comorbidities was performed to compare outcomes.
Results: Out of total 10455 patients admitted with HH, 345 (3.3%) patients had LC. Study showed that the majority of the patients who had LC were males (94.2% vs 5.8%, p< 0.001) and older in age[ >60 yrs(73.9%) vs < 60yrs(26.1%)]. More than half (56.5%) of the HH patients with LC had liver cirrhosis. Further, LC patients had an almost 6-fold higher prevalence of Hepatitis B and C compared to HH patients without LC. HH patients with LC had higher prevalence of diabetes mellitus(40.6% vs 25.6%), peripheral vascular disease(13% vs 5.8%) (p< 0.001). After 1: 1 matching, all-cause in-hospital mortality was found to be significantly higher among HH patients with LC (9.1% vs 3% in non-LC group (p=0.001). While, hospital length of stay (median, 4 vs 3 days, p=0.71) and cost (median 12,355 $ vs 12,273$, p=0.68) were non-significantly higher among LC cohort.
Discussion: Through this study, we noted that all-cause mortality was double in HH patients with coexisting LC. The study also depicts patients with LC and concurrent HH are predominantly males, older in age, and have a higher prevalence of coexisting Hepatitis B and C infections and liver cirrhosis. Therefore, further studies in this field are warranted to develop a more proactive screening approach for this group of fatal cancers, especially in HH patients with coexisting Hepatitis and cirrhosis, to facilitate early interventions and improve morbidity and mortality.
Figure: Baseline characteristics & Outcomes of Hereditary Hemochromatosis patients with Liver Cancer and without Liver Cancer from Jan 2016 to Dec 2018
Shivani Dalal indicated no relevant financial relationships.
Kirtenkumar Patel indicated no relevant financial relationships.
Himanshu Kavani indicated no relevant financial relationships.
Krunalkumar Patel indicated no relevant financial relationships.
Nishi Patel indicated no relevant financial relationships.
Nikita Amin indicated no relevant financial relationships.
Umang Patel indicated no relevant financial relationships.
Shivani Dalal, MD1, Kirtenkumar Patel, MD2, Himanshu Kavani, MD1, Krunalkumar Patel, MD1, Nishi Patel, PharmD3, Nikita Amin, RN1, Umang Patel, DO1. P1821 - Prevalence of Liver Cancer in Hereditary Hemochromatosis and Associated Outcomes: A Propensity-Matched Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.