The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis - PubMed (original) (raw)

Multicenter Study

doi: 10.1002/hep.28414. Epub 2016 Feb 19.

K Rajender Reddy 2, Puneeta Tandon 3, Florence Wong 4, Patrick S Kamath 5, Guadalupe Garcia-Tsao 6, Benedict Maliakkal 7, Scott W Biggins 8, Paul J Thuluvath 9, Michael B Fallon 10, Ram M Subramanian 11, Hugo Vargas 12, Leroy R Thacker 1, Jacqueline G O'Leary 13; North American Consortium for the Study of End-Stage Liver Disease

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Multicenter Study

The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis

Jasmohan S Bajaj et al. Hepatology. 2016 Jul.

Abstract

In smaller single-center studies, patients with cirrhosis are at a high readmission risk, but a multicenter perspective study is lacking. We evaluated the determinants of 3-month readmissions among inpatients with cirrhosis using the prospective 14-center North American Consortium for the Study of End-Stage Liver Disease cohort. Patients with cirrhosis hospitalized for nonelective indications provided consent and were followed for 3 months postdischarge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions and for hepatic encephalopathy (HE), renal/metabolic, and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. Of the 1353 patients enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n = 535; 316 with one, 219 with two or more), with consistent rates across sites. The leading causes were liver-related (n = 333; HE, renal/metabolic, and infections). Patients with cirrhosis and with worse Model for End-Stage Liver Disease score or diabetes, those taking prophylactic antibiotics, and those with prior HE were more likely to be readmitted. The admission model included Model for End-Stage Liver Disease and diabetes (c-statistic = 0.64, after split-validation 0.65). The discharge model included Model for End-Stage Liver Disease, proton pump inhibitor use, and lower length of stay (c-statistic = 0.65, after split-validation 0.70). Thirty percent of readmissions could not be predicted. Patients with liver-related readmissions consistently had index-stay nosocomial infections as a predictor for HE, renal/metabolic, and infection-associated readmissions (odds ratio = 1.9-3.0).

Conclusions: Three-month readmissions occurred in about half of discharged patients with cirrhosis, which were associated with cirrhosis severity, diabetes, and nosocomial infections; close monitoring of patients with advanced cirrhosis and prevention of nosocomial infections could reduce this burden. (Hepatology 2016;64:200-208).

© 2015 by the American Association for the Study of Liver Diseases.

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Figures

Figure 1

Figure 1

Flow of patients through the study.

Figure 2

Figure 2

Proportion of subjects who were re-admitted in 3-months based on reason for index admission. No statistically significant difference was found (p=0.60). HE: hepatic encephalopathy, Renal/Met: renal or metabolic etiology

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