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

Autor: Bajaj JS; Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA., Reddy KR; University of Pennsylvania, Philadelphia, PA., Tandon P; University of Alberta, Edmonton, AB, Canada., Wong F; University of Toronto, Toronto, ON, Canada., Kamath PS; Mayo Clinic, Rochester, MN., Garcia-Tsao G; Yale University, New Haven, CT., Maliakkal B; University of Rochester, Rochester, NY., Biggins SW; University of Colorado, Denver, CO., Thuluvath PJ; Mercy Medical Center, Baltimore, MD., Fallon MB; University of Texas, Houston, TX., Subramanian RM; Emory University, Atlanta, GA., Vargas H; Mayo Clinic, Scottsdale, AZ., Thacker LR; Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA., O'Leary JG; Baylor University Medical Center, Dallas, TX.
Jazyk: angličtina
Zdroj: Hepatology (Baltimore, Md.) [Hepatology] 2016 Jul; Vol. 64 (1), pp. 200-8. Date of Electronic Publication: 2016 Feb 19.
DOI: 10.1002/hep.28414
Abstrakt: Unlabelled: 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.)
Databáze: MEDLINE
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