The Association of Race With Outcomes in Hospitalised Patients With Hepatorenal Syndrome: Nationwide Cohort Study

Introduction: Racial/ethnic disparities have been previously reported in renal and hepatic disease care; however, acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]-AKI) despite its complexity requiring a multidisciplinary approach, remains understudied. Methods: To identify unique associations of clinical and sociodemographic factors with mortality and length of stay (LOS) among patients hospitalised with HRS-AKI, hierarchical regression analysis was conducted, along with a mediation analysis to estimate how race-related differences in in-hospital mortality were influenced by payer type, area household income, and clinical severity. Results: Black patients demonstrated a significantly higher odds of in-hospital mortality, compared to their white counterparts, adjusting for (1) sex and age, (2) sex, age, payer type, and area household income and (3) sex, age, and clinical severity [OR 1.16-1.20, 95% confidence intervals (CI) > 1]. Higher mortality rates among Black patients were partially mediated by clinical severity and area household income [proportion mediated (PM): (0.189)0.19(0.192) and (0.16)0.17(0.18), respectively]. Black patients with HRS-AKI had longer LOS than White patients. Hispanic patients tended to have lower odds of in-hospital mortality [OR: (0.77)0.86(0.97)] despite their lower income and more severe illness. Conclusion: Our nationwide US study demonstrated that, partly due to higher clinical severity and lower household income, Black patients with HRS-AKI experience higher inpatient mortality, compared to White patients. On the other hand, Hispanics with HRS-AKI have a survival advantage. More awareness is warranted to address racial disparities in HRS-AKI outcomes.