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

North American Consortium for the Study of End-Stage Liver Disease

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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).

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalHepatology
Volume64
Issue number1
DOIs
StatePublished - Jul 1 2016

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Fibrosis
End Stage Liver Disease
Hepatic Encephalopathy
Cross Infection
Kidney
Infection
Proton Pump Inhibitors
Liver
Physiologic Monitoring
Gastroenterology
Multicenter Studies
Inpatients
Length of Stay
Logistic Models
Odds Ratio
Anti-Bacterial Agents
Population

ASJC Scopus subject areas

  • Medicine(all)
  • Hepatology

Cite this

The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis. / North American Consortium for the Study of End-Stage Liver Disease.

In: Hepatology, Vol. 64, No. 1, 01.07.2016, p. 200-208.

Research output: Contribution to journalArticle

North American Consortium for the Study of End-Stage Liver Disease 2016, 'The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis', Hepatology, vol. 64, no. 1, pp. 200-208. https://doi.org/10.1002/hep.28414
North American Consortium for the Study of End-Stage Liver Disease. / The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis. In: Hepatology. 2016 ; Vol. 64, No. 1. pp. 200-208.
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AU - North American Consortium for the Study of End-Stage Liver Disease

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AU - Reddy, K. Rajender

AU - Tandon, Puneeta

AU - Wong, Florence

AU - Kamath, Patrick Sequeira

AU - Garcia-Tsao, Guadalupe

AU - Maliakkal, Benedict

AU - Biggins, Scott W.

AU - Thuluvath, Paul J.

AU - Fallon, Michael B.

AU - Subramanian, Ram M.

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AU - Thacker, Leroy R.

AU - O'Leary, Jacqueline G.

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N2 - 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).

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