Hepatocellular carcinoma predicts in-hospital mortality from acute variceal hemorrhage among patients with cirrhosis

OBJECTIVES: Hepatocellular carcinoma (HCC) is a common complication among patients with cirrhosis. Data are limited on the impact of HCC on in-hospital mortality from acute variceal hemorrhage (AVH) in patients with cirrhosis. METHODS: National in-hospital sample (1998 to 2007) was used to analyze admissions with AVH in cirrhotics to study impact of concomitant HCC on the in-hospital mortality. RESULTS: Of 27,442 admissions with cirrhosis and AVH, 540 had HCC. Admissions with HCC differed from those without HCC for age, sex, race, hospital characteristics, and complications of cirrhosis. A total of 2633 (9.6%) patients died during average hospital stay of 6 days with higher in-hospital mortality among admissions with HCC compared with without HCC (19% vs. 9%; P<0.0001). On logistic regression analysis, in-hospital mortality decreased by about 9%/y during 1998 to 2007 [odds ratio, 0.91 (95% confidence interval, 0.89-0.92)]. Receipt of endoscopic treatment was associated with reduced in-hospital mortality. After adjusting for all variables including calendar year and endoscopic treatment, HCC independently predicted in-hospital mortality from AVH: odds ratio, 2.15 (95% confidence interval, 1.67-2.77). Logistic regression model using clinically important variables predicted in-hospital mortality with area under the receiver operating characteristics of 0.80 with strong predictors being presence of HCC, hepatorenal syndrome, hypovolemic shock, sepsis, portosystemic encephalopathy, and use of Sengstaken Blakemore tube. CONCLUSIONS: HCC predicts in-hospital mortality from AVH in patients with cirrhosis. Studies are needed to examine and understand mechanisms of these findings to further develop better modalities of management of AVH in patients with cirrhosis and HCC.