Early readmission predicts mortality in patients with decompensated cirrhosis
The rates of hospitalization and early readmission are high among patients with decompensated cirrhosis, according to a study. Furthermore, an early readmission to an acute care hospital is an independent risk factor for mortality in such patients for at least 1 year following initial hospitalization.
Researchers analysed 5 years of private, employer-based, health insurance claims data associated with HealthCare Services Corporation on 13.5 million members over four states in the US from 2012 to 2014 to investigate the relationship between early readmission and mortality in decompensated cirrhosis.
Early readmission was defined as an admission to a general acute care hospital within 30 days of an index hospitalization. Moreover, mortality was compared to those who were readmitted after 30 days (late readmission).
Researchers used univariable analyses to compare clinical and patient characteristics associated with early readmission, and Cox proportional hazard models with time-varying covariates to determine whether an early readmission was an independent predictor of death.
Overall, 16,107 patients with decompensated cirrhosis were included for analysis. Of these, 82 percent were hospitalized at least once during the study period, and over 50 percent of hospitalized patients had an early readmission.
Compared with patients with a late readmission, those with an early readmission received more frequent blood transfusions, transjugular intrahepatic portosystemic shunt, paracentesis, thoracentesis and upper endoscopies.
Early admission among patients with decompensated cirrhosis also correlated with higher rates of hepatorenal syndrome, sepsis, hepatocellular carcinoma, hepatic encephalopathy and ascites. Furthermore, these patients had higher 90-day, 1-year and overall mortality.
“Early readmission was an independent predictor of worse survival when adjusting for other conditions associated with mortality in patients with cirrhosis, but the impact of an early readmission dissipated after 1 year,” researchers said.