Background: This study aimed to determine the rates of inpatient
palliative care service use and assess the impact of
palliative care service use on in-hospital treatments and resource utilization in hospital admissions for
hepatorenal syndrome. Methods: Using the National Inpatient Sample, hospital admissions with a primary diagnosis of
hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient
palliative care service use. Logistic and linear regression was performed to assess the impact of inpatient
palliative care service on in-hospital treatments and resource use. Results: Of 5571 hospital admissions for
hepatorenal syndrome,
palliative care services were used in 748 (13.4%) admissions. There was an increasing trend in the rate of
palliative care service use, from 3.3% in 2003 to 21.1% in 2014 (p < 0.001). Older age, more recent year of hospitalization,
acute liver failure,
alcoholic cirrhosis, and
hepatocellular carcinoma were predictive of increased
palliative care service use, whereas race other than Caucasian, African American, and Hispanic and
chronic kidney disease were predictive of decreased
palliative care service use. Although hospital admission with
palliative care service use had higher mortality,
palliative care service was associated with lower use of invasive
mechanical ventilation, blood product transfusion, paracentesis, renal replacement, vasopressor but higher DNR status.
Palliative care services reduced mean length of
hospital stay and hospitalization cost. Conclusion: Although there was a substantial increase in the use of
palliative care service in hospitalizations for
hepatorenal syndrome, inpatient
palliative care service was still underutilized. The use of
palliative care service was associated with reduced resource use.