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Goble SR, Ismail AS, Debes JD, Leventhal TM. Critical care outcomes in decompensated cirrhosis: a United States national inpatient sample cross-sectional study. Crit Care 2024; 28:150. [PMID: 38715040 PMCID: PMC11077702 DOI: 10.1186/s13054-024-04938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Prior assessments of critical care outcomes in patients with cirrhosis have shown conflicting results. We aimed to provide nationwide generalizable results of critical care outcomes in patients with decompensated cirrhosis. METHODS This is a retrospective study using the National Inpatient Sample from 2016 to 2019. Adults with cirrhosis who required respiratory intubation, central venous catheter placement or both (n = 12,945) with principal diagnoses including: esophageal variceal hemorrhage (EVH, 24%), hepatic encephalopathy (58%), hepatorenal syndrome (HRS, 14%) or spontaneous bacterial peritonitis (4%) were included. A comparison cohort of patients without cirrhosis requiring intubation or central line placement for any principal diagnosis was included. RESULTS Those with cirrhosis were younger (mean 58 vs. 63 years, p < 0.001) and more likely to be male (62% vs. 54%, p < 0.001). In-hospital mortality was higher in the cirrhosis cohort (33.1% vs. 26.6%, p < 0.001) and ranged from 26.7% in EVH to 50.6% HRS. Mortality when renal replacement therapy was utilized (n = 1580, 12.2%) was 46.5% in the cirrhosis cohort, compared to 32.3% in other hospitalizations (p < 0.001), and was lowest in EVH (25.7%) and highest in HRS (51.5%). Mortality when cardiopulmonary resuscitation was used was increased in the cirrhosis cohort (88.0% vs. 72.1%, p < 0.001) and highest in HRS (95.7%). CONCLUSIONS One-third of patients with cirrhosis requiring critical care did not survive to discharge in this U.S. nationwide assessment. While outcomes were worse than in patients without cirrhosis, the results do suggest better outcomes compared to previous studies.
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Affiliation(s)
- Spencer R Goble
- Department of Medicine, Hennepin Healthcare, 730 South 8th Street, Minneapolis, MN, 55415, USA.
| | - Abdellatif S Ismail
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, 827 Linden Ave, Baltimore, MD, 21201, USA
| | - Jose D Debes
- Department of Medicine, University of Minnesota, Mayo Memorial Building, MMC 250, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
| | - Thomas M Leventhal
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, MMC 36, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA
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2
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Xu X, Gong K, Hong L, Yu X, Tu H, Lan Y, Yao J, Ye S, Weng H, Li Z, Shi Y, Sheng J. The burden and predictors of 30-day unplanned readmission in patients with acute liver failure: a national representative database study. BMC Gastroenterol 2024; 24:153. [PMID: 38702642 PMCID: PMC11067096 DOI: 10.1186/s12876-024-03249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Liver diseases were significant source of early readmission burden. This study aimed to evaluate the 30-day unplanned readmission rates, causes of readmissions, readmission costs, and predictors of readmission in patients with acute liver failure (ALF). METHODS Patients admitted for ALF from 2019 National Readmission Database were enrolled. Weighted multivariable logistic regression models were applied and based on Directed Acyclic Graphs. Incidence, causes, cost, and predictors of 30-day unplanned readmissions were identified. RESULTS A total of 3,281 patients with ALF were enrolled, of whom 600 (18.3%) were readmitted within 30 days. The mean time from discharge to early readmission was 12.6 days. The average hospital cost and charge of readmission were $19,629 and $86,228, respectively. The readmissions were mainly due to liver-related events (26.6%), followed by infection (20.9%). The predictive factors independently associated with readmissions were age, male sex (OR 1.227, 95% CI 1.023-1.472; P = 0.028), renal failure (OR 1.401, 95% CI 1.139-1.723; P = 0.001), diabetes with chronic complications (OR 1.327, 95% CI 1.053-1.672; P = 0.017), complicated hypertension (OR 1.436, 95% CI 1.111-1.857; P = 0.006), peritoneal drainage (OR 1.600, 95% CI 1.092-2.345; P = 0.016), etc. CONCLUSIONS: Patients with ALF are at relatively high risk of early readmission, which imposes a heavy medical and economic burden on society. We need to increase the emphasis placed on early readmission of patients with ALF and establish clinical strategies for their management.
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Affiliation(s)
- Xianbin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Kai Gong
- Department of Infectious Diseases, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Liang Hong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Xia Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Huilan Tu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Yan Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Junjie Yao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Shaoheng Ye
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Haoda Weng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Zhiwei Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China.
| | - Jifang Sheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China.
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3
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Park J, Engstrom G, Ouslander JG. Prescribing Benzodiazepines and Opioids and Clinical Characteristics Associated With 30-Day Hospital Return in Patients Aged ≥75 Years: Secondary Data Analysis. J Gerontol Nurs 2024; 50:25-33. [PMID: 38569101 DOI: 10.3928/00989134-20240312-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE The current study compared prevalence of opioid or benzodiazepine (BZD) prescription and co-prescription of opioids and BZD at discharge and return to a community hospital within 30 days, as well as identified clinical characteristics associated with hospital return in patients aged ≥75 years. METHOD A secondary analysis of a database created during implementation of the Safe Transitions for At Risk Patients program at a 400-bed community teaching hospital in south Florida was conducted. Multivariable logistic regression analyses were performed to identify significant demographic and clinical characteristics associated with return to the hospital within 30 days of discharge. RESULTS A total of 24,262 participants (52.6% women) with a mean age of 85.3 (SD = 6.42) years were included. More than 20% in each central nervous system prescription group (i.e., opioids only, BZD only, opioids and BZD) returned to the hospital within 30 days of discharge. Demographic and chronic conditions (e.g., congestive heart failure, chronic obstructive pulmonary disease, diabetes) and poly-pharmacy were significant factors of a 30-day return to the hospital. CONCLUSION Findings highlight the importance of hospital nurses' role in identifying high-risk patients, educating patients and caregivers, monitoring them closely, communicating with primary care physicians and specialists, and conducting intensive follow up via telephone to avoid 30-day rehospitalization. [Journal of Gerontological Nursing, 50(4), 25-33.].
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Crismale JF, Kim T, Schiano TD. Utilization of aquapheresis among hospitalized patients with end-stage liver disease: A case series and literature review. Clin Transplant 2024; 38:e15221. [PMID: 38109221 DOI: 10.1111/ctr.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/04/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
Third-spacing of fluid is a common complication in hospitalized patients with decompensated cirrhosis. In addition to ascites, patients with advanced cirrhosis may develop significant peripheral edema, which may limit mobility and exacerbate debility and muscle wasting. Concomitant kidney failure and cardiac dysfunction may lead to worsening hypervolemia, which may ultimately result in pulmonary edema and respiratory compromise. Diuretic use in such patients may be limited by kidney dysfunction and electrolyte abnormalities, including hyponatremia and hypokalemia. A slow, continuous form of ultrafiltration known as aquapheresis is a method of extracorporeal fluid removal whereby a pump generates a transmembrane pressure that forces an isotonic ultrafiltrate across a semipermeable membrane. This leads to removal of an ultrafiltrate that is isotonic to blood without the need for dialysate or replacement fluid as is necessary in other forms of continuous kidney replacement therapy. This technique has been utilized in other conditions including acute decompensated heart failure, with trials showing mixed, but generally favorable results. Herein, we present a series of our own experience using aquapheresis among patients with cirrhosis, review the literature regarding its use in other hypervolemic states, and discuss how we may apply lessons learned from use of aquapheresis in heart failure to patients with end-stage liver disease.
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Affiliation(s)
- James F Crismale
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, USA
| | - Tonia Kim
- Division of Nephrology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas D Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, USA
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Li N, Xu M, Liu SY, Yu MQ, Ruan CF. Risk factors for hospital readmission among patients with cirrhosis and ascites in China: a retrospective observational study. J Int Med Res 2024; 52:3000605231223087. [PMID: 38258740 PMCID: PMC10807325 DOI: 10.1177/03000605231223087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE In this investigation, we aimed to explore risk factors for 90-day hospital readmission among patients with cirrhosis and ascites in an Asian population. METHODS In this retrospective study, we included consecutive patients diagnosed with cirrhosis and ascites hospitalized in Renji Hospital between 2018 and 2022 to elucidate risk factors for 90-day readmission. We conducted multivariate logistic regression analysis to identify readmission risk factors. RESULTS We included 265 patients with cirrhosis and ascites. A 43% readmission rate was observed within 90 days. After adjustment for multiple covariates, we found that readmission within 90 days was independently linked to reduced levels of hemoglobin (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.97) and serum albumin (OR 0.88, 95% CI 0.83-0.93), and higher Model for End-Stage Liver Disease and sodium (MELD-Na) scores (OR 1.04, 95% CI 1.01-1.07) at discharge. CONCLUSIONS Patients with cirrhosis who have ascites are frequently rehospitalized within 90 days after discharge. Lower hemoglobin or albumin and higher MELD-Na scores at discharge may be the main risk factors for hospital readmission.
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Affiliation(s)
- Na Li
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Xu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shi-Ying Liu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Qin Yu
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chun-Feng Ruan
- Department of Nursing, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Sikerwar S, Zand S, Steel P, Jesudian A. Management of patients with cirrhosis in the emergency department: Implications for hospitalization outcomes. Liver Transpl 2024; 30:94-102. [PMID: 37851401 DOI: 10.1097/lvt.0000000000000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Sandeep Sikerwar
- New York Presbyterian Weill Cornell Medical Center New York, New York, USA
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sohrab Zand
- New York Presbyterian Weill Cornell Medical Center New York, New York, USA
| | - Peter Steel
- New York Presbyterian Weill Cornell Medical Center New York, New York, USA
| | - Arun Jesudian
- New York Presbyterian Weill Cornell Medical Center New York, New York, USA
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Agbalajobi O, Ebhohon E, Amuchi CB, Nzugang EC, Soladoye EO, Babajide O, Adejumo AC. National frequency, trends, and healthcare burden of care fragmentation in readmissions for end-stage liver disease in the USA. Minerva Gastroenterol (Torino) 2023; 69:470-478. [PMID: 38197846 DOI: 10.23736/s2724-5985.22.03232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND End-stage liver disease (ESLD) patients have frequent readmissions to the same facility or a different hospital (care fragmentation). Care fragmentation results in care delivery from an unfamiliar clinical team or setting, a potential source of suboptimal clinical outcomes. We examined the occurrence, trends, and association between care fragmentation and outcomes during readmissions for ESLD. METHODS From the Nationwide Readmissions Database (January to September 2010-2014), we followed adult (age ≥18 years) hospitalizations for ESLD who were discharged alive for 90 days. During 30- and 90-day readmissions, we calculated the frequency, determinants, and clinical outcomes of care fragmentation (SAS 9.4). RESULTS Of the 67,480 ESLD hospitalizations surviving at discharge from 2010-2014, 35% (23,872) and 52% (35,549) were readmitted in 30- and 90-days respectively. During readmissions, the frequencies of care fragmentation were similar (30-day: 25.4% and 90-day: 25.8%) and remained stable from 2010 to 2014 (P trends>0.5). Similarly, factors associated with care fragmentation were consistent across 30- and 90-day readmissions. These included ages: 18-44 years, liver cancer, receipt of liver transplantation, hepatorenal syndrome, prolonged length of stay, and hospitalization in non-teaching facilities. During 30- and 90-day readmissions, care fragmentation was associated with higher risk of mortality (adjusted mean ratio: 1.13[1.03-1.24] and 1.14 [1.06-1.23]; P values<0.0001), prolonged length of stay (4.6-days vs. 4.1-days and 5.2-days vs. 4.6-days; P values<0.0001), and higher hospital charges ($36,884 vs. $28,932 and $37,354 vs. $30,851; P values<0.0001). CONCLUSIONS Care fragmentation is high among readmissions for ESLD and is associated with poorer outcomes.
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Affiliation(s)
| | - Ebehiwele Ebhohon
- Department of Internal Medicine, Lincoln Medical Center, New York, NY, USA
| | - Chineye B Amuchi
- School of Public Health, Boston University School of Public Health, Boston, MA, USA
| | - Edwige C Nzugang
- Department of Internal Medicine, Beth Israel Lahey Health, Burlington, VT, USA
| | | | - Oyedotun Babajide
- Department of Internal Medicine, Interfaith Medical Center, New York, NY, USA
| | - Adeyinka C Adejumo
- Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA -
- Individualized Genomics and Health Program, Johns Hopkins University, Baltimore, MD, USA
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Twohig PA, Scholten K, Schissel M, Brittan K, Barbaretta J, Samson K, Smith L, Mailliard M, Peeraphatdit TB. Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19 Pandemic. Dig Dis Sci 2023; 68:4381-4388. [PMID: 37864739 DOI: 10.1007/s10620-023-08105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/30/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated. AIMS Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic. METHODS Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods. RESULTS 33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period. CONCLUSION Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.
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Affiliation(s)
- Patrick A Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA.
| | - Kyle Scholten
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Makayla Schissel
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Kevin Brittan
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Jason Barbaretta
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mark Mailliard
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Thoetchai Bee Peeraphatdit
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
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Sohail A, Naseem K, Khan A, Adhami T, Brown K. Predictors of inpatient outcomes of COVID-19 infection in patients with cirrhosis in the early pandemic phase: A nationwide survey. JGH Open 2023; 7:889-898. [PMID: 38162845 PMCID: PMC10757488 DOI: 10.1002/jgh3.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/25/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Previous studies conducted at single centers have suggested that patients with cirrhosis are at a greater risk for worse outcomes with COVID-19. However, there is limited data on a national level in the United States. We aimed to study hospital-related outcomes and identify the predictors of poor outcomes in patients with cirrhosis and concurrent COVID-19. Methods We queried 2020 National Inpatient and Readmission databases to identify all hospitalizations due to cirrhosis in adults with a diagnosis of COVID-19. Primary outcomes included inpatient mortality, mechanical ventilation (MV), and intensive care unit (ICU) utilization. Secondary outcomes included mean length of stay (LOS) and mean hospitalization costs. We classified cirrhosis into compensated (CC) and decompensated (DC) groups. Results We identified 25194 hospitalizations of adult patients due to cirrhosis with a concurrent diagnosis of COVID-19. These patients had higher mortality (19.50% vs 6.19%, P ≤ 0.01), MV (11.7% vs 2.8%, P ≤ 0.01), ICU utilization (17.3% vs 8.1%, P ≤ 0.01), LOS (8.89 days vs 6.16 days, P ≤ 0.01), and total hospitalization costs ($24 817 vs $18 505, P ≤ 0.01) than those without COVID-19. On subgroup analysis, patients in the DC group had higher mortality, LOS, and hospitalization costs compared to those in the CC group. On multivariate analysis, we also found that COVID-19 infection, age, Charlson Comorbidity Index ≥3, acute kidney injury, end-stage renal disease, septic shock, acute respiratory failure, MV, and ICU status were independent predictors for mortality. Conclusion Our study suggests that COVID-19 infection is an independent predictor of mortality in patients with cirrhosis, with threefold higher mortality and increased resource utilization. Early intervention through immunizations and advanced COVID-19 therapies can help improve these outcomes.
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Affiliation(s)
- Abdullah Sohail
- Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | | | - Ahmad Khan
- Department of Gastroenterology and HepatologyCase Western Reserve UniversityClevelandOhioUSA
| | | | - Kyle Brown
- Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Sherman Z, Wahid N, Wagner M, Soltani A, Rosenblatt R, Fortune B, Lucero C, Schoenfeld E, Brown R, Jesudian A. Integration of Cirrhosis Best Practices Into Electronic Medical Record Documentation Associated With Reduction in 30-Day Mortality Following Hospitalization. J Clin Gastroenterol 2023; 57:951-955. [PMID: 36730665 DOI: 10.1097/mcg.0000000000001787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hospital admissions for patients with cirrhosis continue to increase. In New York City, 25% to 30% of hospitalized cirrhotics are readmitted within 30 days. Rehospitalization is associated with increased mortality, poor quality of life, and financial burden to patients, hospitals, and payers. Preventable readmissions are partially accounted for by a well-documented quality gap between evidence-based guidelines for cirrhosis management and real-world adherence to these recommendations. METHODS We performed a prospective cohort study that compared outcomes among cirrhotic patients admitted to 4 internal medicine teams over a 6-month period. An electronic medical record (EMR) note template that outlined best-practice measures for cirrhotics was developed. Inpatient providers on 2 teams were instructed to include it in daily progress notes and discharge summaries. The recommended practices included diagnostic paracentesis and diuretics for ascites, rifaximin, and lactulose for hepatic encephalopathy, beta blockers for esophageal varices, and antibiotic prophylaxis for spontaneous bacterial peritonitis. The remaining 2 teams continued the standard of care for cirrhotic patients. The primary outcome was 30-day readmissions. Secondary outcomes included in-hospital mortality, 30-day mortality, length of stay, and adherence to best-practice guidelines. RESULTS Over a 6-month period, 108 cirrhotic patients were admitted, 83 in the interventional group and 25 in the control group. MELD-Na scores on admission did not differ between the groups (20.1 vs. 21.1, P =0.56). Thirty-day readmissions were not significantly different between the interventional and control groups (19.3% vs. 24%, P =0.61). However, 30-day mortality was significantly lower in the interventional group (8.4% vs. 28%, P =0.01). There was no difference between the 2 groups in in-hospital mortality (4.8% vs. 0%, P =0.27), 90-day mortality (15.7% vs. 28.0%, P =0.17) or length of stay (10.2 vs. 12.6 d, P =0.34). Adherence to best-practice metrics was similar between the groups, except for rates of diagnostic paracentesis, which were higher in the interventional group (98% vs. 80%, P =0.01). CONCLUSION Implementation of an EMR note template with cirrhosis best practices was associated with lower 30-day mortality and higher rates of diagnostic paracentesis among admitted patients with cirrhosis. These findings suggest that the integration of best-practice measures into the EMR may improve outcomes in hospitalized cirrhotic patients. Larger studies are required to validate these findings.
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Affiliation(s)
- Zachary Sherman
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical College
| | - Nabeel Wahid
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Michael Wagner
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Amin Soltani
- Division of Gastroenterology, Massachusetts General Hospital
| | - Russell Rosenblatt
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
| | - Brett Fortune
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
| | - Catherine Lucero
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
| | - Emily Schoenfeld
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
| | - Robert Brown
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
| | - Arun Jesudian
- Center for Liver Disease and Transplantation, NewYork Presbyterian Hospital/Weill Cornell Medical College
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Elhence H, Dodge JL, Farias AJ, Lee BP. Quantifying days at home in patients with cirrhosis: A national cohort study. Hepatology 2023; 78:518-529. [PMID: 36994701 PMCID: PMC10363198 DOI: 10.1097/hep.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND AIMS Days at home (DAH) is a patient-centric metric developed by the Medicare Payment Advisory Commission, capturing annual health care use, including and beyond hospitalizations and mortality. We quantified DAH and assessed factors associated with DAH differences among patients with cirrhosis. APPROACH AND RESULTS Using a national claims database (Optum) between 2014 and 2018, we calculated DAH (365 minus mortality, inpatient, observation, postacute, and emergency department days). Among 20,776,597 patients, 63,477 had cirrhosis (median age, 66, 52% males, and 63% non-Hispanic White). Age-adjusted mean DAH for cirrhosis was 335.1 days (95% CI: 335.0 to 335.2) vs 360.1 (95% CI: 360.1 to 360.1) without cirrhosis. In mixed-effects linear regression, adjusted for demographic and clinical characteristics, patients with decompensated cirrhosis spent 15.2 days (95% CI: 14.4 to 15.8) in postacute, emergency, and observation settings and 13.8 days (95% CI: 13.5 to 14.0) hospitalized. Hepatic encephalopathy (-29.2 d, 95% CI: -30.4 to -28.0), ascites (-34.6 d, 95% CI: -35.3 to -33.9), and combined ascites and hepatic encephalopathy (-63.8 d, 95% CI: -65.0 to -62.6) were associated with decreased DAH. Variceal bleeding was not associated with a change in DAH (-0.2 d, 95% CI: -1.6 to +1.1). Among hospitalized patients, during the 365 days after index hospitalization, patients with cirrhosis had fewer age-adjusted DAH (272.8 d, 95% CI: 271.5 to 274.1) than congestive heart failure (288.0 d, 95% CI: 287.7 to 288.3) and chronic obstructive pulmonary disease (296.6 d, 95% CI: 296.3 to 297.0). CONCLUSIONS In this national study, we found that patients with cirrhosis spend as many, if not more, cumulative days receiving postacute, emergency, and observational care, as hospitalized care. Ultimately, up to 2 months of DAH are lost annually with the onset of liver decompensation. DAH may be a useful metric for patients and health systems alike.
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Affiliation(s)
- Hirsh Elhence
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer L. Dodge
- Department of Population Public Health Sciences, University of Southern California, Los Angeles, California
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California
| | - Albert J. Farias
- Department of Population Public Health Sciences, University of Southern California, Los Angeles, California
| | - Brian P. Lee
- Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California
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12
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Lonardo A. Shutting those revolving doors. Ann Hepatol 2023; 28:101106. [PMID: 37088419 DOI: 10.1016/j.aohep.2023.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Amedeo Lonardo
- Azienda Ospedaliero-Universitaria, Ospedale Civile di Baggiovara, Modena, Italy.
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13
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Maia JC, Bertoncello KCG, de Souza SDS, Locks MOH, Martins SR, Lorenzini E. Validation of a Guideline for Nurses Taking Care of Patients With Liver Cirrhosis in the Context of COVID-19 in the Emergency Department. Gastroenterol Nurs 2023; 46:128-137. [PMID: 36779975 PMCID: PMC10044590 DOI: 10.1097/sga.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/07/2022] [Indexed: 02/14/2023] Open
Abstract
The objective of this study was to prepare and validate the content of a guideline for nursing care of adult patients with liver cirrhosis and COVID-19 treated in the emergency department. The study was conducted in two stages: first, the guideline was developed based on an integrative literature review and existing guidelines on the topic. The guideline was prepared with six domains and 64 care items. In the second stage, 15 specialists in urgency and emergency services performed content validation of the guideline. The data were analyzed using the Content Validity Index, with reliability assessed through Cronbach's α. The judges validated the guide regarding language clarity, objectivity, theoretical relevance, and practical pertinence. The value of the guideline's Content Validity Index was 0.96. Cronbach's α reliability reached a value of 0.93. The judges validated all domains and items of the guideline for theoretical relevance and practical pertinence, to be used by researchers and clinical practice professionals in the nursing area.
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Affiliation(s)
- Jéssica Costa Maia
- Correspondence to: Jéssica Costa Maia, MS, RN, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil ()
| | - Kátia Cilene Godinho Bertoncello
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Sabrina da Silva de Souza
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Melissa Orlandi Honório Locks
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Sabrina Regina Martins
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
| | - Elisiane Lorenzini
- Jéssica Costa Maia, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Kátia Cilene Godinho Bertoncello, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina da Silva de Souza, PhD, RN, is Researcher, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Melissa Orlandi Honório Locks, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Sabrina Regina Martins, MS, RN, is Doctoral Student, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
- Elisiane Lorenzini, PhD, RN, is Adjunct Professor, Graduate Program in Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Trindade, Florianópolis, Santa Catarina, Brazil
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14
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Patel AH, Li Y, Minacapelli CD, Catalano K, Rustgi V. Reduction in Gastrointestinal Cancers in Cirrhotic Patients Receiving Rifaximin vs Lactulose Only Therapy for Hepatic Encephalopathy. Cureus 2023; 15:e35259. [PMID: 36974238 PMCID: PMC10039763 DOI: 10.7759/cureus.35259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Background Rifaximin and/or lactulose therapy is widely used in cirrhotic patients for the prevention and treatment of hepatic encephalopathy. The incidence of gastrointestinal cancers in these patients on lactulose, rifaximin, and/or combination therapy is unknown. We investigated the possible effect of lactulose and rifaximin on cancer risk in patients with cirrhosis using the MarketScan database. Methods A retrospective cohort study was conducted using the Truven Health MarketScan Commercial Claims databases from 2007-2017. An index date was defined for each participant as the earliest date of cirrhosis diagnosis. A baseline period for each participant was defined as the 12 months prior to the first medication date while the study follow-up period represented the period from the initiation of the medication to its cessation. ANOVA was used to compare all continuous measures of age and duration of medication. Wald Chi-square tests were performed to test the associations between the study groups. Results A total of 12,409 patients were included in our study. The rifaximin only cohort had the greatest reduction in risk of developing colon cancer, esophageal cancer, and stomach cancer compared to the other groups. Rifaximin reduced the risk of colon cancer and esophageal cancer by 59.42% and 70.37%, respectively, compared to patients taking lactulose only. Patients in the lactulose plus rifaximin cohort had the highest rate of development of pancreatic cancer (lactulose plus rifaximin vs rifaximin only vs lactulose only, 0.45% vs 0.24% vs 0.21%; P < 0.0001) and liver and intrahepatic bile duct cancers (11.73% vs 5.84% vs 5.49%; P < 0.0001). Conclusion Colon, esophageal, and gastric cancers had a marked incidence reduction in the rifaximin only cohort compared to the other cohorts studied.
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15
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Rosenstengle C, Kripalani S, Rahimi RS. Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care. J Hosp Med 2022; 17 Suppl 1:S17-S23. [PMID: 35972038 DOI: 10.1002/jhm.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
One of the most costly and frequent causes of hospital readmissions in the United States is hepatic encephalopathy in patients with underlying liver cirrhosis. In this narrative review, we cover current practices in inpatient management, transitions of care, and strategies to prevent hospital readmissions. Bundled approaches using a model such as the "Ideal Transitions of Care" appear to be more likely to prevent readmissions and assist patients as they transition to outpatient care. Numerous strategies have been evaluated to prevent readmissions in patients with hepatic encephalopathy, including technologic interventions, involvement of nonphysician team members, early follow-up strategies, and involvement of palliative care when appropriate.
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Affiliation(s)
- Craig Rosenstengle
- Division of Gastroenterology & Hepatology, Baylor University Medical Center, Dallas, Texas, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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16
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Singal AK, DiMartini A, Leggio L, Arab JP, Kuo YF, Shah VH. Identifying Alcohol Use Disorder in Patients With Cirrhosis Reduces 30-Days Readmission Rate. Alcohol Alcohol 2022; 57:576-580. [PMID: 35544033 PMCID: PMC9465529 DOI: 10.1093/alcalc/agac015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Readmission is frequent among patients with cirrhosis and is a complex multifactorial process. To examine the association of alcohol use disorder (AUD) and risk of readmission in patients with alcohol-associated cirrhosis. METHODS AND RESULTS National Readmission Dataset (2016-2017) was used to extract a retrospective cohort of 53,348 patients with primary or secondary discharge diagnosis code of alcohol-associated cirrhosis with their first admission (26,674 patients with vs. propensity matched 26,674 without a primary or secondary discharge diagnosis code of AUD). Readmission within 30-day was lower (43.9 vs. 48%, P < 0.001) among patients identified to have AUD at the time of discharge. In a conditional logistic regression model, a diagnosis of AUD was associated with 15% reduced odds of 30-day readmission, 0.85 (0.83-0.88). Furthermore, the reason for readmission among patients identified vs. not identified to have AUD was less likely to be liver disease complication. The findings remained similar in a matched cohort of patients where the AUD diagnosis at discharge was listed as one of the secondary diagnoses only. CONCLUSION Although, our study findings suggest that identification of AUD at the time of discharge among patients hospitalized for alcohol-associated cirrhosis reduces the risk of 30-day readmission, unavailable information on patient counseling, referral for mental health specialist and treatment received for AUD limit the causality assessment. Future studies are needed overcoming the inherent limitations of the database to establish the role of identification and treatment of AUD in reducing readmission and liver decompensation in patients with alcohol-associated cirrhosis.
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Affiliation(s)
- Ashwani K Singal
- Department of Medicine, University of South Dakota, Vermillion, SD, USA.,Avera Transplant Institute and McKennan University Hospital, Sioux Falls, SD, USA
| | - Andrea DiMartini
- Departments of Psychiatry and Transplant Surgery, and the Clinical and Translational Science Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Bethesda, MD, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
| | - Juan P Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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17
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Rogers MP, Kuo PC. Identifying and mitigating factors contributing to 30-day hospital readmission in high risk patient populations. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1610. [PMID: 34926654 PMCID: PMC8640920 DOI: 10.21037/atm-2021-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/26/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Michael P Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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18
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Ebhohon E, Ogundipe OA, Adejumo AC. Alarming rate of 30-day hospital readmissions in patients with liver cirrhosis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1608. [PMID: 34926652 PMCID: PMC8640909 DOI: 10.21037/atm-21-5258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Ebehiwele Ebhohon
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | - Adeyinka Charles Adejumo
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.,Individualized Genomics and Health Program, Johns Hopkins University, Baltimore, MD, USA
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