OBJECTIVES : Hepatic encephalopathy (HE) is a complex and reversible neuropsychiatric syndrome that is associated with growing, substantial healthcare resource utilization. The primary aim of this study was to examine the demographics, clinical characteristics, readmission rate, and hospitalization cost of patients hospitalized with HE as well as to identify potential temporal trends. The secondary aim was to identify predictors of readmission and hospitalization cost.

METHODS : We conducted a cross-sectional study using the Nationwide Readmissions Database from 2010 to 2014 and constructed cohorts of adults hospitalized with HE for each year in the United States. Readmission rates were assessed based on multivariate logistic regression. Linear and Tweedie regression models were used to establish temporal trends in patient characteristics and hospitalization cost. Weighted hierarchical logistic regression and generalized linear mixed models were used to identify predictors for nationally representative readmissions and hospitalization costs, respectively.

RESULTS : The number of index hospitalization with HE increased with a significant trend from 34,967 in 2010 to 44,791 in 2014. Among them, an average of 16.8% were readmitted within 30 days each year. Predictors of readmission included male sex (OR: 0.95, 95% CI: 0.91-0.98), Elixhauser readmission score ≥25 (OR: 0.86, 95% CI: 0.83-0.90), elective readmission (OR: 1.15, 95% CI: 1.02-1.30), patient’s state residential status (OR: 1.48, 95% CI: 1.31-1.67), primary payer (Medicare and Medicaid, OR: 0.87, 95% CI: 0.82-0.93; Other/self-pay OR: 1.32 95% CI 1.21-1.45), number of diagnoses >13 (OR: 1.23, 95% CI: 1.17-1.28), and length of stay >4 days (OR: 1.19, 95% CI: 1.14-1.24).

CONCLUSIONS : Our results indicate there is a need to implement better management strategies to improve outcomes in patients hospitalized with HE to reduce healthcare resource utilization, which will ultimately curb the increase in the economic burden associated with the disease.