P4590 - Racial and Ethnic Disparities in Outcomes of Acute Liver Failure Hospitalizations in the United States

Supriya Maheshwari, MBBS¹, Apoorva Doshi, MBBS², Ritik M. Goyal, MBBS³, Udita Gupta, MD¹, Mohamed Shoreibah, MD^4
1University of Alabama at Birmingham, Birmingham, AL; ²Seth Gordhandas Sundardas Medical College and KEM Hospital, Surat, Gujarat, India; ³Rutgers New Jersey Medical School, Newark, NJ; ⁴University of Alabama at Birmingham Hospital, Birmingham, AL

Introduction: Acute liver failure (ALF) is a condition of grave prognosis and high mortality, but recent advances in the liver transplant and intensive care management have improved the rates of survival in affected patients. Few studies have evaluated the association between race and outcomes in patients with ALF in the past. Our objective was to determine whether racial disparities exist in outcomes of hospitalizations with acute liver failure.

Methods: We analyzed United States hospitalizations from 2016 to 2020 using the Nationwide Inpatient Sample (NIS). Adults (≥18 years) admitted with an ICD 10 diagnosis of ALF were included and categorized based on race (White, Black, Hispanic, and Others). We carried out survey-weighted logistic and linear regression analyses to determine the association between race/ethnicity and primary outcome (in-hospital mortality) and secondary outcomes (length of hospital stay [LOS], total hospitalization charge, receipt of liver transplant). We adjusted for the potential confounders (sex, income quartile, payer status, hospital size, location, teaching status, and Elixhauser comorbidities) and accounted for clustering by hospital-year.

Results: Of 347,900 hospitalizations for ALF (median age 62 [52-71] years); 56.4% were males, 66% Whites, 14% Hispanics, 12% Blacks, and 7% other races. As compared to White patients, Black patients had higher in-hospital mortality (adjusted odds ratio [aOR] 1.42, 95% confidence interval [CI]: 1.39-1.46, p < 0.05) and longer LOS (White vs Black, 8.3 vs 10.6 days; p < 0.05). White patients had the lowest total charge of hospitalization, followed by Hispanic, Black, and other patients (p < 0.05 for all). Black patients had lower odds of receiving a liver transplant than White patients (aOR 0.62; 95% CI 0.54-0.73; p < 0.05), while no significant differences were noted for Hispanic patients or other races/ethnicities. (Table 1)

Discussion: Racial and ethnic disparities exist in outcomes among patients hospitalized for ALF. Black race was independently associated with higher in-hospital mortality, longer LOS, higher total charge, and lower odds of receiving a liver transplant when compared to White patients. Further studies are required to determine if access to care and delayed hospital presentation are contributing factors to the racial disparities, and to develop strategies to address them.


Disclosures:


Supriya Maheshwari, MBBS¹, Apoorva Doshi, MBBS², Ritik M. Goyal, MBBS³, Udita Gupta, MD¹, Mohamed Shoreibah, MD⁴. P4590 - Racial and Ethnic Disparities in Outcomes of Acute Liver Failure Hospitalizations in the United States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.