Background/Purpose: Cirrhosis is associated with a host of complications such as coagulopathy, renal impairment, esophageal varices, peritonitis, and increased mortality. Rheumatoid arthritis (RA) is a chronic inflammatory arthropathy that has been associated with liver damage. Some agents used to treat RA can have hepatotoxic effects as well. We aim to use nationally available patient data to identify predictors of complications in hospitalized cirrhotic patients with RA.

Methods: Patients with a diagnosis of liver cirrhosis were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on presence of RA. Diagnoses were identified based on ICD-10 codes. Data were collected regarding incidence of shock, sepsis, peritonitis, acute kidney injury (AKI), variceal bleed, Hepatorenal syndrome (HRS), portal vein thrombosis (PVT), hepatic failure, intensive care unit (ICU) admission, and death. Other variables included age, gender, race, primary insurance, median income, hospital region, hospital bed size, length of stay (LOS), total hospitalization charges, and Charlson comorbidities. Significant predictors of outcomes among cirrhotic patients with RA were analyzed using multivariate regression analysis.

Results: A total of 778,679 patients with a diagnosis of liver cirrhosis were included in the study. Of these, 12,775 (1.6%) had a concurrent diagnosis of RA. Mean age in the RA group was 64.5 years compared to 60.3 years in the non-RA group. The majority of patients in the RA group were female (66.0%), White (70.0%), and had Medicare insurance (65.1%). After adjusting for confounders, significant predictors of in-hospital mortality among cirrhotic patients with RA were age (aOR 1.04, P < 0.001), Native American race (aOR 2.44, P = 0.04), Northeast hospital region (aOR 1.64, P = 0.001), and Medicaid insurance (aOR 1.99, P = 0.02). Women had higher odds of variceal bleed (aOR 1.56, P = 0.04). Higher odds of PVT were seen in medium-sized hospitals (aOR 2.77, P = 0.02). Males (aOR 1.44, P = 0.01) and uninsured patients (aOR 4.2, P = 0.02) had higher odds of developing HRS. Patients hospitalized in the Midwest (aOR 1.61, P = 0.01), the West (aOR 1.81, P = 0.007), and those with Medicaid insurance (aOR 1.36, P = 0.04) had higher odds of hepatic failure. Higher odds of AKI were seen in men (aOR 1.26, P = 0.002) and Black patients (aOR 1.37, P = 0.03). Resource utilization was not significantly different between the two groups.

Conclusion: Our study identified demographic predictors of cirrhosis-related complications and in-hospital mortality in cirrhotic patients with RA. Further studies are needed to assess the socioeconomic, genetic, and physiologic mechanisms underlying our findings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-adverse-events-and-complications-in-cirrhotic-patients-with-rheumatoid-arthritis-a-nationwide-analysis/