St. Mary Medical Center Langhorne, PA, United States
Himanshu Kavani, MD1, Shivani Dalal, MD1, Krunalkumar Patel, MD1, Kirtenkumar Patel, MD2, 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: The spectrum of liver disease ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Owing to the high prevalence of NASH and the consequent burden of progressive liver disease, there is mounting epidemiological evidence that NASH has rapidly become a leading etiology underlying many cases of Hepatocellular carcinoma (HCC).
Methods: Adult patients admitted with NASH, with and without HCC were analyzed from January 2016 to December 2018 using the National Inpatient Sample database. We used propensity score matching to balance the differences in baseline characteristics and comorbidities between the two groups. The primary outcome was to determine the burden of HCC in NASH hospitalization. Secondary outcomes included all-cause in-hospital mortality, length of stay (LOS), and total hospital costs. SAS 9.4 software was used for statistical analysis.
Results: Out of 293665 patients admitted with NASH, 8245(2.8%) had concurrent HCC. The HCC cohort consists of patients who are older in age (67.1±8.7 vs. 61.5±13.2 yrs), predominantly male(56.6% vs. 37.4%) compared to those without HCC (p< 0.001). NASH patients with HCC had almost 2-fold and 3-fold higher prevalence of Hep B and Hep C, respectively. All other comorbidities such as congestive heart failure, hypertension, chronic pulmonary disease, obesity, renal failure. were lower in the HCC cohort when compared to those without HCC. After propensity matching, we observed higher mortality (6.3% vs. 4.3%, p< 0.001) in patients with NASH and concurrent HCC. Patients with HCC have a higher inpatient hospital stay [5(3-8) vs. 4(2-7)days, p< 0.001]. We noted the cost of hospitalization is significantly higher [12892$(7015-26860) vs. 9694$(5839-16748), p< 0.001] in the former group.
Discussion: HCC is typically diagnosed late in its course, with a median survival following diagnosis of approximately 6 to 20 months. This study showed that patients with NASH and concurrent HCC are older and have a higher prevalence of coexisting Hepatitis B and C infections, higher hospital length of stay, hospitalization cost, and mortality. Further study in this field is warranted to develop a more proactive screening approach for this fatal cancer, especially in patients with coexisting Hepatitis B and C infections with NASH, to help improve morbidity and mortality.
Figure: Baseline characteristics & Outcomes of NASH patients with HCC and without HCC from Jan 2016 to Dec 2018
Disclosures: Himanshu Kavani indicated no relevant financial relationships. Shivani Dalal indicated no relevant financial relationships. Krunalkumar Patel indicated no relevant financial relationships. Kirtenkumar 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.
Himanshu Kavani, MD1, Shivani Dalal, MD1, Krunalkumar Patel, MD1, Kirtenkumar Patel, MD2, Nishi Patel, PharmD3, Nikita Amin, RN1, Umang Patel, DO1. P1783 - Baseline Characteristics and Outcomes of Patients With NASH Who Develop Hepatocellular Carcinoma: National Perspective on Hospitalized Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.