The Three-Month Readmission Rate Remains Unacceptably High in a Large North American Cohort of Cirrhotic Patients.

Link to article at PubMed

The Three-Month Readmission Rate Remains Unacceptably High in a Large North American Cohort of Cirrhotic Patients.

Hepatology. 2015 Dec 21;

Authors: Bajaj JS, Reddy KR, Tandon P, Wong F, Kamath PS, Garcia-Tsao G, Maliakkal B, Biggins SW, Thuluvath PJ, Fallon MB, Subramanian RM, Vargas H, Thacker LR, O'Leary JG, NACSELD

Abstract
In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-center perspective study is lacking.
AIM: To evaluate the determinants of 3-month readmissions in cirrhotic inpatients using the prospective 14-center NACSELD (North American Consortium for the Study of End-Stage Liver Disease) cohort.
METHODS: Cirrhotics hospitalized for non-elective indications were consented and followed for 3-months post-discharge. 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.
RESULTS: 1353 patients were enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n=535;316 with one, 219 with ≥2), with consistent rates across sites. The leading causes were liver-related (n=333, HE, renal/metabolic and infections). Cirrhotics with worse MELD, diabetes, those taking prophylactic antibiotics and with prior HE, were more likely to be readmitted. The admission model included MELD and diabetes (c-statistic=0.64; after split-validation 0.65). The discharge model included MELD, proton pump inhibitor use and lower length-of-stay (c-statistic=0.65; after split-validation 0.70). 30% 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 (OR 1.9-3.0).
CONCLUSIONS: Three-month readmissions occurred in about half of discharged cirrhotics, which were associated with cirrhosis severity, diabetes and nosocomial infections. Close monitoring of advanced cirrhotics and prevention of nosocomial infections could reduce this burden. This article is protected by copyright. All rights reserved.

PMID: 26690389 [PubMed - as supplied by publisher]

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