Sakkarin Chirapongsathorn1, Kittiyod Poovorawan2, Ngamphol Soonthornworasiri3, Wirichada Pan-ngum3, Amnart Chaiprasert4, Kamthorn Phaosawasdi5, Sombat Treeprasertsuk6

1Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Royal Thai Army, 2Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 3Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 4Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Royal Thai Army, 5Division of Gastroenterology, Vichaiyut Hospital, 6Division of Gastroenterology, Department of Medicine, Chulalongkorn University

Background/Aims: Accurate population-based data are needed on the rate, economic impact, and the long-term outcome of acute on chronic liver failure (ACLF) in hospitalized patients with cirrhosis.

We aimed to determine time trends in the epidemiology, economic burden, and mortality of ACLF in Thailand.

Methods: We conducted a nationwide, population-based, cohort study involving all hospitalized patients with cirrhosis in Thailand during the period from 2009 through 2013, using data from the National Health Security Office. The primary outcomes were trends in hospitalizations, hospital costs, and inpatient mortality.

Results: The number of hospitalizations for ACLF in Thailand doubled from 3,185 in 2009 to 7,666 in 2013. The average cost per hospitalization for ACLF was 3.5-fold higher than that for cirrhosis (61,928 versus 16,995 baht). The hospital gets paid by using a diagnosis-related group (DRG) payment system which is only 15% of the average costs of treatment (9,371 from 61,928 baht). The in-hospital fatality rate was 51% for ACLF and the additional fatality rate was 85% up to 1 year. The organ failure trends in ACLF showed sepsis with septic shock and renal failure were the majority proportion. Age, male sex, and the number and types of organ failure were predictors of death in ACLF.

Conclusion: Cirrhosis and ACLF represent a substantial and increasing health and economic burden in Thailand. These data highlight an urgent need for national health care policy and research on mechanisms of disease and effective therapy to target high-risk patients with cirrhosis for care.

Keywords: cirrhosis, acute-on-chronic live, cost analysis