Predictors of Pulmonary Hypertension among Hospitalized Patients with Cirrhosis

1.1 Objectives: Liver cirrhosis portends significant morbidity and mortality. Pulmonary hypertension (PH) is a serious extra-hepatic complication of cirrhosis. Our objective was to define the demographic and clinical diagnosis associated with all forms of PH in a sample of hospitalized adult patients.

1.2 Methods: We analyzed the 2001 to 2010 Nationwide Inpatient Sample (NIS). Adult (aged ≥ 21 years) patients with cirrhosis were identified using International Classification of Disease 9th Revision, Clinical Modification (ICD9-CM) codes 571.2, 571.5 and 571.6. The prevalence of PH was the primary outcome, and was identified using ICD9-CM codes 416.0 and 416.8. We controlled for other known conditions associated with pulmonary hypertension. We also controlled for patient and hospital factors associated with the diagnosis of PH.

1.3 Results: Cirrhosis was a discharge diagnosis in 847,690 of cases. The majority of patients with cirrhosis were white (52.2%, n = 442,813), male (61.8%, n= 523,567), and insured (87.4%, n=802,975). A concurrent diagnosis of PH was recorded in 2.38% (n = 20146). Patients with PH tended to be > 60 years of age (54.3%), white (55.1%) with a predominance of non-alcoholic cirrhosis (64.6%). In a multivariable analysis, female gender (OR 1.35; 95% CI, 1.25–1.46), obesity (OR 1.71; 95%CI, 1.44-2.04), and Native American race (1.215; 95% CI, 1.014 -1.454) were associated with increased odds of PH. Hepatic encephalopathy was associated with a reduced odds of PH (OR 0.88; 95% CI, 0.81-0.97).No specific liver disease etiology was associated with PH, though non-alcoholic cirrhosis (1.377; 95% CI, 0.996-1.903) was marginally associated with greater odds.

1.4 Conclusion: Among hospitalized patients with liver cirrhosis, female gender, obesity, and Native American race were associated with increased odds, and hepatic encephalopathy was associated with a reduced odds for PH.