Abstract: Impact of Chronic Hepatitis C Infection on Inpatient Outcomes and Complications Among Patients With Hepatocellular Carcinoma: A National Inpatient Sample Analysis (2020-2022).
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality. Although chronic hepatitis C virus (HCV) infection has historically been a major driver of HCC, the proportion of HCC related to metabolic, alcohol-associated, and other nonviral liver diseases has been increasing. In the era of direct-acting antivirals, the clinical profile and outcomes of HCV-related HCC may differ from those of HCC from other causes. We evaluated differences in inpatient outcomes and complications among hospitalized patients with HCC with versus without chronic HCV infection in the United States.
We performed a retrospective study using the National Inpatient Sample (NIS) from 2020-2022, a weighted national database of U.S. hospitalizations. Adults aged ≥18 years with HCC, with or without chronic HCV infection, were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), total hospital charges, and complications including hepatic failure, hepatorenal syndrome (HRS), sepsis, variceal bleeding, and spontaneous bacterial peritonitis (SBP). Multivariable logistic and linear regression models adjusted for demographics, comorbidities, insurance, income quartile, and hospital characteristics.
Among 148,475 HCC hospitalizations, 16% had chronic HCV infection. Compared with non-HCV HCC hospitalizations, HCV-related cases were younger, more often male, had a higher proportion of Black patients and fewer White patients, and were more likely to have Medicaid coverage and lower income status (all p<0.05). In adjusted analyses, chronic HCV was not associated with higher in-hospital mortality (OR 0.94; p=0.33) or longer LOS, but was associated with lower total hospital charges (-$9,900; p<0.05). HCV-positive patients had lower odds of sepsis (OR 0.86), but higher odds of hepatic failure (OR 1.14) and variceal bleeding (OR 1.27), with no significant differences in HRS or SBP.
Chronic HCV accounted for a minority of recent HCC hospitalizations and was not associated with worse short-term inpatient outcomes. Differences in complications likely reflect underlying liver disease burden rather than HCV status alone.
We performed a retrospective study using the National Inpatient Sample (NIS) from 2020-2022, a weighted national database of U.S. hospitalizations. Adults aged ≥18 years with HCC, with or without chronic HCV infection, were identified using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), total hospital charges, and complications including hepatic failure, hepatorenal syndrome (HRS), sepsis, variceal bleeding, and spontaneous bacterial peritonitis (SBP). Multivariable logistic and linear regression models adjusted for demographics, comorbidities, insurance, income quartile, and hospital characteristics.
Among 148,475 HCC hospitalizations, 16% had chronic HCV infection. Compared with non-HCV HCC hospitalizations, HCV-related cases were younger, more often male, had a higher proportion of Black patients and fewer White patients, and were more likely to have Medicaid coverage and lower income status (all p<0.05). In adjusted analyses, chronic HCV was not associated with higher in-hospital mortality (OR 0.94; p=0.33) or longer LOS, but was associated with lower total hospital charges (-$9,900; p<0.05). HCV-positive patients had lower odds of sepsis (OR 0.86), but higher odds of hepatic failure (OR 1.14) and variceal bleeding (OR 1.27), with no significant differences in HRS or SBP.
Chronic HCV accounted for a minority of recent HCC hospitalizations and was not associated with worse short-term inpatient outcomes. Differences in complications likely reflect underlying liver disease burden rather than HCV status alone.