medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2019, Number 1

<< Back Next >>

Ann Hepatol 2019; 18 (1)

Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort

Patel R, Poddar P, Choksi D, Pandey V, Ingle M, Khairnar H, Sawant P

Language: English
References: 25
Page: 30-39
PDF size: 194.72 Kb.


ABSTRACT

Introduction and aim. Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort. Material and methods. We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs. Results. 1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p ‹ 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1- month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score ›14 at discharge and serum sodium ‹ 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001). Conclusions. High rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.


REFERENCES

  1. Balla U, Malnick S, Schattner A. Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems. Medicine 2008; 87: 294-300.

  2. Wong EL, Cheung AW, Leung MC, Yam CH, Chan FW, Wong FY, Yeoh EK. Unplanned readmission rates, length of hospital stay, mortality, and medical costs of ten common medical conditions: a retrospective analysis of Hong Kong hospital data. BMC Health Serv Res 2011; 11: 149.

  3. Hernandez AF, Greiner MA, Fonarow GC, Hammill BG, Heidenreich PA, Yancy CW, Peterson ED, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 2010; 303: 1716-22.

  4. Gudmundsson G, Gislason T, Janson C, Lindberg E, Hallin R, Ulrik CS, Brondum E, et al. Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. Eur Respir J 2005; 26: 414.

  5. Heron M. Deaths: Leading causes for 2010. National vital statistics reports. Vol. 62. No. 6. Hyattsville, MD: National Center for Health Statistics 2013.

  6. Fleming KM, Aithal GP, Card TR, West J. All-cause mortality in people with cirrhosis compared with the general population: a population-based cohort study. Liver Int 2012; 32(1): 79-84.

  7. Kanwal F, Volk M, Singal A, Angeli P, Talwalkar J. Improving quality of health care for patients with cirrhosis. Gastroenterology 2014; 147: 1204-7.

  8. Berman K, Tandra S, Forssell K, Vuppalanchi R, Burton JR Jr, Nguyen J, Mullis D, et al. Incidence and predictors of 30- day readmission among patients hospitalized for advanced liver disease. Clin Gastroenterol Hepatol 2011; 9(3): 254-9.

  9. Volk ML, Tocco RS, Bazick J, Rakoski MO, Lok AS. Hospital readmissions among patients with decompensated cirrhosis. Am J Gastroenterol 2012; 107(2): 247-52.

  10. Bajaj JS, Reddy KR, Tandon P, Wong F, Kamath PS, Garcia- Tsao G, Maliakkal B, et al. 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. Hepatology 2016; 64(1): 200-8.

  11. Singal AG, Rahimi RS, Clark C, Ma Y, Cuthbert JA, Rockey DC, Amarasingham R. An automated model using electronic medical record data identifies patients with cirrhosis at high risk for readmission. Clin Gastroenterol Hepatol 2013; 11(10): 1335-41.

  12. Ganesh S, Rogal SS, Yadav D, Humar A, Behari J. Risk factors for frequent readmissions and barriers to transplantation in patients with cirrhosis. PLoS One 2013; 8(1): e55140.

  13. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31(4): 864-71.

  14. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007; 45: 797-805.

  15. Katoonizadeh A, Decaestecker J, Wilmer A, Aerts R, Verslype C, Vansteenbergen W, Yap P, et al. MELD score to predict outcome in adult patients with non-acetaminophen-induced acute liver failure. Liver Int 2007; 27(3): 329-34.

  16. Kim HY, Kim CW, Kim TY, Song DS, Sinn DH, Yoon EL, Jung YK, et al. Korean Acute-on-Chronic Liver Failure Study Group. Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis. World J Gastroenterol 2016; 22(41): 9205-13.

  17. Singal AK, Kamath PS, Gores GJ, Shah VH. Alcoholic hepatitis: current challenges and future directions. Clin Gastroenterol Hepatol 2014; 12(4): 555-64.

  18. Leise MD, Kim WR, Kremers WK, Larson JJ, Benson JT, Therneau TM. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology 2011; 140(7): 1952.

  19. Biggins SW, Rodriguez HJ, Bacchetti P, Bass NM, Roberts JP, Terrault NA. Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology 2005; 41(1): 32-9.

  20. Ruf AE, Kremers WK, Chavez LL, Descalzi VI, Podesta LG, Villamil FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl 2005; 11(3): 336-43.

  21. Kalra A, Wedd JP, Biggins SW. Changing prioritization for transplantation: MELD-Na, hepatocellular carcinoma exceptions, and more. Curr Opin Organ Transplant 2016; 21(2): 120-6.

  22. Garg V, Garg H, Khan A, Trehanpati N, Kumar A, Sharma BC, Sakhuja P, et al. Granulocyte colony-stimulating factor mobilizes CD34(+) cells and improves survival of patients with acute-on-chronic liver failure. Gastroenterology 2012; 142(3): 505-12.

  23. Duseja A. Nonalcoholic fatty liver disease in India - a lot done, yet more required! Indian J Gastroenterol 2010; 29(6): 217-25.

  24. Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, Baijal R, et al. Prevalence of non-alcoholic fatty liver disease: population based study. Ann Hepatol 2007; 6(3): 161-3.

  25. Nagral S, Nanavati A, Nagral A. Liver Transplantation in India: At the Crossroads. J Clin Exp Hepatol 2015; 5(4): 329-40.




2020     |     www.medigraphic.com