Cirrhosis Is Associated with Increased Mortality in Patients with Diverticulitis: A Nationwide Cross-Sectional Study

Kruger, Andrew J.; Mumtaz, Khalid; Anaizi, Ahmad; Modi, Rohan M.; Hussan, Hisham; Zhang, Cheng; Hinton, Alice; Conwell, Darwin L.; Krishna, Somashekar G.; Stanich, Peter P.

doi:10.1007/s10620-017-4782-9

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…According to these criteria, decompensation is defined by the presence of ascites, HE, variceal bleeding, or SBP. The ICD‐9‐CM codes used to identify those diagnoses are shown in Supporting Table and are comparable to those used in previous publications . We excluded patients less than 18 years of age (n = 266) and those discharged from the hospital during the month of December 2013 (n = 12,848) because of expected unavailability of 30‐day follow‐up data.…”

Section: Methodsmentioning

confidence: 99%

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Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

et al. 2019

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One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of simple risk scoring model with high generalizability, based on demographics, clinical features and interventions can bring refinement to the prediction of 30-day readmission in high risk patients. Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population. This article is protected by copyright. All rights reserved.

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Section: Methodsmentioning

confidence: 99%

“…The ICD-9-CM codes used to identify those diagnoses are shown in Supporting Table S1 and are comparable to those used in previous publications. (16,17) We excluded patients less than 18 years of age (n = 266) and those discharged from the hospital during the month of December 2013 (n = 12,848) because…”

Section: Study Populationmentioning

confidence: 99%

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

et al. 2019

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“…Previous studies have shown that the presence of DC independently increases mortality rates for other gastrointestinal diseases, including diverticulitis, peptic ulcer disease, Clostridium difficle infections, [25][26][27] along with non-gastrointestinal bacterial infections. The higher index admission mortality was heavily influenced by an increased mortality rate of 3.3% within those patients with decompensation.…”

Section: Discussionmentioning

confidence: 99%

“…The higher index admission mortality was heavily influenced by an increased mortality rate of 3.3% within those patients with decompensation. Previous studies have shown that the presence of DC independently increases mortality rates for other gastrointestinal diseases, including diverticulitis, peptic ulcer disease, Clostridium difficle infections, [25][26][27] along with non-gastrointestinal bacterial infections. 28 This appears to be the case for ABP as well.…”

Section: Discussionmentioning

confidence: 99%

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

Patel

Mumtaz

et al. 2019

J of Gastro and Hepatol

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Background and Aim Despite higher rates of gallstones in patients with cirrhosis, there are no population‐based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high‐risk population. Methods We utilized the Nationwide Readmission Database (2011–2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30‐day readmission, index admission mortality, and calendar year mortality. Results Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30‐day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30‐day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30‐day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78). Conclusions The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.

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“…Besides mortality, LOS, total hospital cost, and discharge disposition, which were variables in the dataset, all the other outcomes were identified using ICD-9-CM codes. The liver cirrhosis and the Baveno4 system codes have been extensively used and validated in the NIS [ 24 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis

Adejumo

Adegbala

Adejumo

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals. Methods We analyzed hospital discharge records of adults (age ≥ 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to nonusers on 1:1 ratio (4,728:4,728), using a propensity-based matching system, with a stringent algorithm. We then used conditional regression models with generalized estimating equations to measure the adjusted prevalence rate ratio (aPRR) for having liver cirrhosis (and its complications), carcinoma, mortality, discharge disposition, and the adjusted mean ratio (aMR) of total hospital cost and length of stay (LOS) [SAS 9.4]. Results Our study revealed that cannabis users (CUs) had decreased prevalence of liver cirrhosis (aPRR: 0.81[0.72-0.91]), unfavorable discharge disposition (0.87[0.78-0.96]), and lower total health care cost ($39,642[36,220-43,387] versus $45,566[$42,244-$49,150]), compared to noncannabis users (NCUs). However, there was no difference among CUs and NCUs on the incidence of liver carcinoma (0.79[0.55-1.13]), in-hospital mortality (0.84[0.60-1.17]), and LOS (5.58[5.10-6.09] versus 5.66[5.25-6.01]). Among CUs, dependent cannabis use was associated with lower prevalence of liver cirrhosis, compared to nondependent use (0.62[0.41-0.93]). Conclusions Our findings suggest that cannabis use is associated with decreased incidence of liver cirrhosis, but no change in mortality nor LOS among HCV patients. These novel observations warrant further molecular mechanistic studies.

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Cirrhosis Is Associated with Increased Mortality in Patients with Diverticulitis: A Nationwide Cross-Sectional Study

Abstract: Presence of cirrhosis in patients hospitalized for diverticulitis is associated with an increased mortality rate. These are novel findings, and future clinical studies should focus on improving diverticulitis outcomes in this group.

Cited by 11 publications

References 28 publications

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database

Index admission cholecystectomy for acute biliary pancreatitis favorably impacts outcomes of hospitalization in cirrhosis

Reduced Incidence and Better Liver Disease Outcomes among Chronic HCV Infected Patients Who Consume Cannabis

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