Mortality and 30-day readmissions among hepatocellular carcinoma patients hospitalized for portal vein thrombosis: A nationwide analysis.

505 Background: Portal vein thrombosis (PVT), although considered rare in the general population, has a prevalence that varies significantly depending on the underlying disease severity and imaging modality. Common predisposing conditions include cirrhosis, various malignancies, and inflammatory and infectious processes. Our study aims to identify PVT events in patients with hepatocellular carcinoma (HCC), assess mortality and associated variables, and evaluate readmission causes. Methods: HCC adults(≥18 years) admitted with PVT as the primary diagnoses during the index admission were queried from the Nationwide Readmissions Database (NRD 2016-2022) using pretested ICD-10 codes. COVID positive cases were excluded from both index admissions and readmissions. The mortality rate during index admission was calculated and we used multivariable regression models to identify factors that could be linked with index mortality. We then estimated the 30-day readmission rates among survivors, and the mortality rate among readmissions and possible causes were also sought. Results: We found 1556 cases of PVT during index admission, of which 100(6.43%) died during the same admission. The majority of the index admissions were males (74.47%) with a mean age of 64.28 years. Of those who survived, 297(19.1%) were discharged as home health care. Higher odds of death during index admission were found in patients with cachexia (aOR 6.30, 95% CI 1.59-2.05), metastasis (aOR 7.45, 95% CI 2.92-18.98), acute/subacute liver failure (aOR 7.03, 95% CI 2.35-21.07), encephalopathy (aOR 5.62, 95% CI 1.83-17.23), acute kidney injury(AKI)(aOR 9.53, 95% CI 3.89-23.37), reported myocardial infarction during their stay (aOR 22.86, 95% CI 1.89-277.08) and those using palliative care (aOR 7.43, 95% CI 2.62-21.07), (p<0.05 throughout). Mean ages of patients who died versus those who survived the index admission were 65.42 versus 64.20 years (aOR 1.03, 95% CI 0.98-1.08, p=0.203). No significant differences in index mortality were found based on sex, insurance type, weekend admission, year of admission, or comorbidities including dyslipidemia, smoking, diabetes, chronic kidney disease, obesity, COPD, liver cirrhosis, frailty status, heart failure, presence of ascites, or reported ischemic stroke. Among those who survived, 32.55% were readmitted within 30 days, with 9.18% having a primary diagnosis of sepsis and 4.17% due to recurrent PVT. The mortality rate following readmission was 18.59%. Conclusions: In conclusion, certain underlying conditions increase the odds of inpatient death among HCC patients with PVT. The higher readmission mortality was primarily due to the occurrence of intercurrent illnesses, with sepsis being one of the leading factors. The higher mortality and readmission rates among cancer patients warrant improved management, education, and research initiatives.