Rising Cardiometabolic Comorbidity and Inpatient Resource Utilization Among Hospitalized Patients with Hepatocellular Carcinoma, 2018–2022

Background Hospitalizations for hepatocellular carcinoma (HCC) increasingly involve a complex interaction of chronic liver disease, cardiometabolic comorbidities, and systemic complications, which now exert greater influence than tumor-specific factors alone. However, contemporary data on how the evolving comorbidity burden affects inpatient resource utilization and procedural care are limited. This study evaluates national trends in inpatient characteristics, procedural utilization, and outcomes among patients hospitalized with HCC from 2018 to 2022. Methods A retrospective, cross-sectional analysis of adult hospitalizations was performed using the National Inpatient Sample (NIS) from 2018 to 2022. Hospitalizations involving HCC were identified through ICD-10 diagnosis codes, encompassing both principal and secondary diagnoses. Survey-weighted analyses were used to estimate national prevalence, in-hospital mortality, length of stay (LOS), and total hospital charges. Temporal trends were evaluated using survey-weighted logistic or linear regression, with calendar year as a continuous variable. Multivariable survey-weighted logistic regression models were constructed to identify adjusted predictors of inpatient mortality and procedural utilization, including liver transplantation, hepatic resection, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Results During the study period, an estimated 275,000 HCC-related hospitalizations occurred nationwide. The prevalence of cardiometabolic comorbidities increased significantly over time (all p< 0.001), including MASLD (6.6% to 8.7%), obesity (10.6% to 13.7%), diabetes (36.0% to 38.9%), and dyslipidemia (26.4% to 34.4%). In-hospital mortality rose from 8.82% (95% CI, 8.40-9.24%) in 2018 to 9.23% (95% CI, 8.81-9.65%) in 2022, with the highest rate in 2020 (9.42%). In parallel, inpatient resource utilization rose, as reflected by longer lengths of stay and higher hospitalization charges. Utilization of diagnostic endoscopic procedures, such as esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography, increased, whereas rates of definitive inpatient oncologic and portal hypertension–directed interventions—including liver transplantation, hepatic resection, and TIPS—remained low and stable. In-hospital mortality was independently associated with markers of hepatic decompensation and systemic illness, including hepatic encephalopathy, acute kidney injury, sepsis, and hepatorenal syndrome. These associations were stronger than those observed for tumor-directed procedures, as reflected by inpatient procedural utilization patterns. Conclusions Between 2018 and 2022, inpatient resource utilization among patients hospitalized with hepatocellular carcinoma increased in parallel with rising cardiometabolic comorbidity and was driven primarily by the management of hepatic decompensation and systemic illness rather than oncologic intervention. These findings characterize the evolving complexity of HCC hospitalizations in the contemporary inpatient setting.