Presentation Details
The effect of Budd-Chiari Syndrome (BCS) in hospitalized hepatocellular carcinoma patients (HCC): A nationwide analysis.

Ekrem G Turk, Ayobami Olafimihan, Khaldun Obeidat, Youjin Oh, Lina James, Angelo Caputi Zuniga, Alejandro Vallejo.

John H.Stroger, Jr.Hospital of Cook County, Chicago, IL, USA

Abstract


Backgrounds: HCC is a major global health challenge, being the most prevalent type of primary liver cancer and the sixth leading cause of cancer-related mortality worldwide, with a 5-year relative survival rate of 20.3%. BCS, characterized by obstruction of hepatic venous outflow, can significantly influence liver pathology and has been identified as a contributing factor to the onset of HCC. Though rare, a recognized connection exists between BCS and the subsequent development of HCC, the specific impact of BCS in patients primarily diagnosed with HCC, particularly regarding inpatient outcomes, remains underexplored. This nationwide study aims to elucidate the effects of BCS in hospitalized patients with a primary diagnosis of HCC, thereby providing valuable insights into the implications of this vascular complication in the HCC patient population. Methods: Nationwide Inpatient Sample (NIS) was queried to determine adult hospitalizations with a primary diagnosis of HCC using ICD-10 codes. The primary outcome was defined as the effect of BCS on inpatient mortality. Secondary outcomes included length of stay (LOS), total hospital cost (THC), health care utilization, ICU admission. We evaluated the baseline characteristics using the t-test and chi-square test. Multivariable logistic regression analysis assessed the association of HCC with BCS and inpatient mortality adjusted by other variables. Results: In a cohort of 62,300 HCC admissions, 1% had BCS. While HCC with BCS tended to be younger (mean age 63.2 vs. 64.8), more often female (26% vs. 25%), and more frequently African American (18.7% vs. 16.6%), with higher income and Medicaid coverage (25.8% vs. 24%) compared to without BCS, these differences were not statistically significant. However, a significant disparity was observed in the Charlson Comorbidity Index, with a higher proportion of HCC with BCS scoring greater than 3 (36% vs. 22%; p <0.001). Inpatient mortality for the entire HCC cohort was 8.2%, with a non-significant higher rate in the BCS subgroup (11.4%). Key factors associated with inpatient mortality included age, Charlson index, male gender, African-American race, and hospital teaching status and location. The mean LOS for HCC with BCS was longer (7.4 days) than those without BCS (5.7 days). The mean THC was higher in the BCS group ($105,937 vs. $91,518). Rates of ICU transfer were 5.7% for the BCS group and 3.9% for those without BCS, showing no significant difference, as was the case with other secondary outcomes. Conclusion: The apparent lack of statistical significance in many comparisons may be attributed to the relatively small proportion of HCC patients with concurrent BCS (1% of the cohort). This limited representation could potentially mask underlying associations and effects. Therefore, the observed trends, though not statistically significant, should not be disregarded in clinical context. Given the small sample size of HCC patients with BCS, further studies employing methods like propensity score analysis could provide a more nuanced understanding of the impact of BCS on HCC patients. While this study provides valuable preliminary data, its findings underscore the need for more in-depth research to fully understand the implications of BCS in HCC patients, particularly regarding clinical outcomes.

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