Table 1.
Demographic Characteristics, Comorbidities, Clinical Severity, and Causes at Admission
| Variable | Overall (1998–2013) (n = 2070) |
Early (1998–2005) (n = 989) |
Later (2006–2013) (n = 1081) |
P Value† | |||
|---|---|---|---|---|---|---|---|
| Total Patients, n |
Value* | Total Patients, n |
Value* | Total Patients, n |
Value* | ||
| Median age (IQR), y | 2070 | 39.0 (29.0–52.0) | 989 | 38.0 (28.0–49.0) | 1081 | 41.0 (30.0–53.0) | <0.001 |
|
| |||||||
| Female | 2070 | 1434 (69.3) | 989 | 680 (68.8) | 1081 | 754 (69.8) | 0.62 |
|
| |||||||
| Race | 2070 | 989 | 1081 | 0.050 | |||
|
| |||||||
| White | 1581 (76.4) | 768 (77.7) | 813 (75.2) | ||||
|
| |||||||
| African American | 299 (14.4) | 124 (12.5) | 175 (16.2) | ||||
|
| |||||||
| Other | 190 (9.2) | 97 (9.8) | 93 (8.6) | ||||
|
| |||||||
| Ethnicity | 2066 | 989 | 1077 | 0.70 | |||
|
| |||||||
| Hispanic/Latino | 191 (9.2) | 94 (9.5) | 97 (9.0) | ||||
|
| |||||||
| Other | 1875 (90.8) | 895 (90.5) | 980 (91.0) | ||||
|
| |||||||
| Comorbidities | |||||||
| Hypertension | 2069 | 364 (17.6) | 989 | 133 (13.5) | 1080 | 231 (21.4) | <0.001 |
|
| |||||||
| Heart disease | 2069 | 168 (8.1) | 989 | 55 (5.6) | 1080 | 113 (10.5) | <0.001 |
|
| |||||||
| Renal disease | 2069 | 119 (5.8) | 989 | 52 (5.3) | 1080 | 67 (6.2) | 0.36 |
|
| |||||||
| Diabetes/endocrine disease | 2069 | 336 (16.2) | 989 | 118 (11.9) | 1080 | 218 (20.2) | <0.001 |
|
| |||||||
| Psychiatric illness | 2069 | 701 (33.9) | 989 | 266 (26.9) | 1080 | 435 (40.3) | <0.001 |
|
| |||||||
| Substance dependency | 2069 | 469 (22.7) | 989 | 205 (20.7) | 1080 | 264 (24.4) | 0.044 |
|
| |||||||
| Met SIRS criteria at admission | 2011 | 1293 (64.3) | 965 | 630 (65.3) | 1046 | 663 (63.4) | 0.37 |
|
| |||||||
| Median HE grade at admission (IQR) | 2020 | 2.0 (1.0–4.0) | 989 | 2.0 (1.0–4.0) | 1031 | 2.0 (1.0–4.0) | 0.42 |
|
| |||||||
| HE severity at admission | 2020 | 989 | 1031 | 0.48 | |||
|
| |||||||
| Mild (grade 1 or 2) | 1068 (52.9) | 515 (52.1) | 553 (53.6) | ||||
|
| |||||||
| Deep (grade 3 or 4) | 952 (47.1) | 474 (47.9) | 478 (46.4) | ||||
|
| |||||||
| Median time from symptom onset to initial hospitalization (IQR), d | 1996 | 3.0 (0.0–11.0) | 970 | 3.0 (1.0–14.0) | 1026 | 2.0 (0.0–8.0) | <0.001 |
|
| |||||||
| Median time from symptom onset to HE (IQR), d | 1989 | 4.0 (1.0–14.0) | 973 | 4.0 (1.0–15.0) | 1016 | 4.0 (1.0–12.0) | 0.062 |
|
| |||||||
| Median BMI (IQR), kg/m2 | 1663 | 26.8 (23.3–31.6) | 761 | 26.3 (22.9–31.2) | 902 | 27.3 (23.7–31.8) | 0.007 |
|
| |||||||
| Median systolic blood pressure at admission (IQR), mm Hg | 2059 | 124.0 (110.0–140.0) | 984 | 125.0 (110.0–140.0) | 1075 | 123.0 (110.0–140.0) | 0.33 |
|
| |||||||
| Median diastolic blood pressure at admission (IQR), mm Hg | 2059 | 68.0 (58.0–79.0) | 984 | 68.0 (58.0–79.0) | 1075 | 68.0 (57.0–78.0) | 0.79 |
|
| |||||||
| Primary cause | 2061 | 989 | 1072 | – | |||
|
| |||||||
| APAP toxicity | 955 (46.3) | 450 (45.5) | 505 (47.1) | ||||
|
| |||||||
| Pregnancy | 19 (0.9) | 7 (0.7) | 12 (1.1) | ||||
|
| |||||||
| Hepatitis A virus infection | 37 (1.8) | 28 (2.8) | 9 (0.8) | ||||
|
| |||||||
| Hepatitis B virus infection | 148 (7.2) | 76 (7.7) | 72 (6.7) | ||||
|
| |||||||
| Ischemia/shock | 117 (5.7) | 36 (3.6) | 81 (7.6) | ||||
|
| |||||||
| Autoimmune hepatitis | 145 (7.0) | 54 (5.5) | 91 (8.5) | ||||
|
| |||||||
| Drug-induced liver injury | 222 (10.8) | 123 (12.4) | 99 (9.2) | ||||
|
| |||||||
| Indeterminate | 251 (12.2) | 138 (14.0) | 113 (10.5) | ||||
|
| |||||||
| Wilson disease | 26 (1.3) | 17 (1.7) | 9 (0.8) | ||||
|
| |||||||
| Budd–Chiari syndrome | 15 (0.7) | 10 (1.0) | 5 (0.5) | ||||
|
| |||||||
| Mushroom toxicity | 12 (0.6) | 4 (0.4) | 8 (0.8) | ||||
|
| |||||||
| Other virus | 19 (0.9) | 8 (0.8) | 11 (1.0) | ||||
|
| |||||||
| Other cause‡ | 95 (4.6) | 38 (3.8) | 57 (5.3) | ||||
|
| |||||||
| Etiologic group | 2061 | 989 | 1072 | 0.46 | |||
|
| |||||||
| APAP toxicity | 955 (46.3) | 450 (45.5) | 505 (47.1) | ||||
|
| |||||||
| Non-APAP cause | 1106 (53.7) | 539 (54.5) | 567 (52.9) | ||||
|
| |||||||
| Favorability of cause | 2061 | 989 | 1072 | 0.072 | |||
|
| |||||||
| Favorable§ | 1128 (54.7) | 521 (52.7) | 607 (56.6) | ||||
|
| |||||||
| Unfavorable∥ | 934 | 933 (45.3) | 438 | 468 (47.3) | 496 | 465 (43.4) | 0.22 |
|
| |||||||
| APAP overdose intentionality | |||||||
|
| |||||||
| Suicidal | 367 (39.3) | 183 (41.8) | 184 (37.1) | ||||
|
| |||||||
| Unintentional | 485 (51.9) | 222 (50.7) | 263 (53.0) | ||||
|
| |||||||
| Unknown | 82 (8.8) | 33 (7.5) | 49 (9.9) | ||||
APAP = n-Acetyl-p-Aminophenol; BMI = body mass index; HE = hepatic encephalopathy; IQR = interquartile range; SIRS = systemic inflammatory response syndrome.
*
Number (percentage) unless otherwise indicated.
†
For comparison of early and later periods. Boldface values are statistically significant.
‡
Includes 3 patients with hepatitis C virus infection and 3 with hepatitis E virus infection.
§
Includes APAP toxicity, ischemia, hepatitis A virus infection, and pregnancy.
∥
Includes indeterminate cause, drug-induced liver injury, autoimmune hepatitis, hepatitis B virus infection, other viruses, Wilson disease, Budd–Chiari syndrome, mushroom toxicity, and other causes.