The landscape of inpatient admissions for alcoholic hepatitis in the era of early liver transplantation

Introduction and Objectives: Liver transplant (LT) is a recent option available in the United States (US) to treat those with severe, refractory alcoholic hepatitis (AH). We examined changes in clinical characteristics of patients admitted with AH and tracked hospital outcomes as practice changes involving LT have shifted. Materials and Methods: Using the National Inpatient Sample, we performed a cross-sectional analysis of patients admitted with AH during the years 2016–2020 in the US. Differences in clinical characteristics over time were assessed. To compare outcomes between 2016–2017 (when LT was less common) and 2018–2020 (when LT was more common), we conducted linear and logistic regression. Propensity-score matching was used compare outcomes between patients with and without LT. Results: From 2016–2017 to 2018–2020, patients admitted with AH tended to have a higher frequency of infection (p = 0.006), hepatorenal syndrome (<0.001), and ascites (<0.001). Hospital costs and length of stay (LOS) were highest in transplant hospitals, and costs rose over time in both non-transplant (NT) teaching and non-teaching hospitals (p < 0.001). Mortality decreased in NT teaching hospitals [aOR 0.7 (95% CI: 0.6–0.8)] and slightly decreased in NT non-teaching hospitals [aOR 0.7 (95% CI: 0.5–1.0)]. In the propensity-matched cohort involving LT versus non-LT patients, there was a 10% absolute reduction in-hospital mortality, but this came at a higher cost (p < 0.001) and length of stay (p < 0.001). Conclusions: The severity of AH has been increasing over time, yet mortality has declined, after adjusting for severity of disease. Patients who underwent LT survived; however, the healthcare burden of LT is substantial.