Deleterious effect of cirrhosis on outcomes after motor vehicle crashes using the nationwide inpatient sample

Am J Gastroenterol. 2008 Jul;103(7):1674-81. doi: 10.1111/j.1572-0241.2008.01814.x. Epub 2008 Jul 4.


Objectives: Alcohol abuse and minimal hepatic encephalopathy may predispose cirrhotics to a higher motor vehicle crash (MVC) rate. Cirrhotics have poor post-trauma outcomes on small-scale studies. The aim was to examine the effect of cirrhosis on mortality, charges, and length of stay (LOS) after MVCs using the Nationwide Inpatient Sample (NIS) 2004.

Methods: NIS 2004 was queried for cirrhotics with MVC (C-MVC), cirrhotics only, and MVC only for demographics, comorbidities, hospital characteristics, and the Injury Severity Score (ISS). C-MVC patients were compared with the other groups. Weighted uni/multivariate regression was performed for all MVCs (with/without cirrhosis).

Results: There were 560,080 discharges for cirrhosis only, 262,244 for MVC only, and 1,565 for C-MVC. C-MVC patients were significantly younger (49.8 yr vs 58.6 yr, P < 0.0005) and had less comorbidities than cirrhosis only, but had similar mortality (C-MVC 10.8% vs cirrhosis only 9.9%, P= 0.23). C-MVC patients (49.8 yr) were older than MVC only patients (43.7 yr, P < 0.0005). C-MVC patients also had significantly higher mortality (10.8%) compared with MVC only (3.1%, P < 0.0005) despite similar ISS. C-MVC patients had significantly greater LOS (9.6 days) and charges ($67,119) compared with both MVC only (6.2 days, $43,314) and cirrhosis only (7.4 days, $35,522). Cirrhosis (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.5-5.5) and age >65 yr (OR 5.2, 95% CI 4.4-6.0) were most commonly associated with mortality. Male sex, high ISS, self-pay, teaching, and large and urban hospitals were also significantly associated with mortality. On multivariate regression, cirrhosis was associated with greater charges and LOS.

Conclusion: Cirrhosis is associated with greater mortality, LOS, and charges after MVC despite controlling for injury severity, comorbidities, and age in NIS 2004.

MeSH terms

  • Accidents, Traffic*
  • Adult
  • Age Factors
  • Aged
  • Comorbidity
  • Female
  • Hepatic Encephalopathy / complications
  • Hospitalization / economics
  • Humans
  • Length of Stay
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis, Alcoholic / complications
  • Male
  • Middle Aged
  • United States / epidemiology
  • Wounds and Injuries / mortality*