Epidemiology and Outcomes of Hospitalizations for Children with Encephalopathy Associated with Severe Liver Dysfunction.

Objective: To determine patient-level and hospital-level factors independently associated with mortality in pediatric severe liver dysfunction-associated encephalopathy. Study design: This was retrospective analysis of hospitalizations of children 0-20 years old with severe liver dysfunction-associated encephalopathy in the US, using combined administrative data from the 2016, 2019, and 2022 versions of the Kids' Inpatient Database. National estimates of hospitalizations were generated, and multivariable logistic regression models were constructed to determine patient and hospital characteristics independently associated with mortality. Results: Of an estimated 3378 hospitalizations nationally, 94% were to urban teaching hospitals, 67% were of children >5 years, and 56% were of male patients. Comorbidities and multiple organ dysfunction (MOD) were present in 93% and 97% of hospitalizations, respectively. In-hospital mortality was 45%, with average hospital stay of 22 days, and average hospital charge of $622 069 (2022 US dollars). In-hospital mortality was associated with patient characteristics including age, MOD, and the presence of comorbidities, but not hospital characteristics. In comparison with infants, hospitalization of older children was associated with lower odds of mortality. Independent association with greater odds of mortality was observed for each nonhepatic organ dysfunction (OR 1.50; 95% CI 1.38-1.64), and the presence of comorbidities (OR 4.10; 95% CI 2.75-6.13). Conclusions: Nearly 1 in 2 hospitalizations for pediatric severe liver dysfunction-associated encephalopathy ended in death. Hospitalizations occurred predominantly at urban hospitals, with no regional or hospital variation in mortality. Efforts to mitigate mortality need to be individualized and age-specific, with emphasis on preventing or alleviating MOD.