{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:22:27Z","timestamp":1747149747269,"version":"3.40.5"},"reference-count":37,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Hepatorenal syndrome (HRS) is a life\u2010threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching\/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with HRS were identified from the national inpatient sample 2016\u20132019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non\u2010teaching hospitals (NTHs), teaching non\u2010transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching\/transplant status and in\u2010hospital mortality and transplant\u2010free mortality was examined using multivariable linear and logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non\u2010TTCs (aOR\u2009=\u20090.75, 95% CI: 0.68\u20130.83, <jats:italic>P<\/jats:italic>\u2009&lt;0.001). Patients at TTCs had a lower transplant\u2010free mortality risk than those at NTHs (aOR\u2009=\u20090.75, 95% CI: 0.67\u20130.83, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). There was no significant difference in all\u2010cause or transplant\u2010free mortality between TNTCs and NTHs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12985","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T07:26:01Z","timestamp":1701156361000},"page":"848-854","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159\u2009845 hospitalizations"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8365-7240","authenticated-orcid":false,"given":"Aalam","family":"Sohal","sequence":"first","affiliation":[{"name":"Department of Hepatology Liver Institute Northwest  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hunza","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of California  Fresno California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dino","family":"Dukovic","sequence":"additional","affiliation":[{"name":"Department of Medicine Ross University School of Medicine  Miramar Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kris V.","family":"Kowdley","sequence":"additional","affiliation":[{"name":"Department of Hepatology Liver Institute Northwest  Seattle Washington USA"},{"name":"Department of Medicine, Elson S. 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