TY - JOUR
T1 - Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis
AU - Peeraphatdit, Thoetchai (Bee)
AU - Kamath, Patrick S.
AU - Karpyak, Victor M.
AU - Davis, Brian
AU - Desai, Vivek
AU - Liangpunsakul, Suthat
AU - Sanyal, Arun
AU - Chalasani, Naga
AU - Shah, Vijay H.
AU - Simonetto, Douglas A.
N1 - Publisher Copyright:
© 2020 AGA Institute
PY - 2020/2
Y1 - 2020/2
N2 - Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.
AB - Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.
KW - Addiction Treatment
KW - Alcohol Abstinence
KW - Alcohol Use Disorder
KW - Chemical Dependency
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U2 - 10.1016/j.cgh.2019.04.048
DO - 10.1016/j.cgh.2019.04.048
M3 - Article
C2 - 31042580
AN - SCOPUS:85077654594
SN - 1542-3565
VL - 18
SP - 477-485.e5
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 2
ER -