Early Readmission Predicts Increased Mortality in Cirrhosis Patients After Clostridium difficile Infection

Kruger, Andrew J.; Durkin, Claire; Mumtaz, Khalid; Hinton, Alice; Krishna, Somashekar G.

doi:10.1097/mcg.0000000000001090

Cited by 10 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mortality in CDI patients might be related to age, albumin levels, leukocytes count and renal failure [ 36 ]. Several studies identified risk factors associated with mortality in cirrhotic patients, which acquired CDI [ 37 , 38 , 39 ]. While ICU admission and albumin were recognized as predictors of short-term mortality, we identified some risk factors related to CDI severity, such as leukocytes, CRP and Atlas score, and to the liver disease—mainly Child–Pugh score and MELD.…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

View full text Add to dashboard Cite

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

show abstract

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Clostridium difficile infections (CDIs) also proved to serve as predictors for early readmission in cirrhosis . The Nationwide Readmissions Database in the United States reports that patients with cirrhosis and CDIs were more likely to be readmitted within 30 days and have higher mortality rates than those without cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Chirapongsathorn

Poovorawan²,

Soonthornworasiri³

et al. 2020

Hepatol Commun

View full text Add to dashboard Cite

Accurate population‐based data are needed on the rate, economic impact, and the long‐term outcomes of readmission among patients with cirrhosis. To examine the rates, costs, and 1‐year outcomes of patients readmitted within 30 days following their index hospitalization for complications of cirrhosis, we conducted a nationwide, population‐based cohort study involving all patients with cirrhosis in Thailand from 2009 through 2013, using data from the National Health Security Office databases, which included those from nationwide hospitalizations. Readmission was captured from hospitals at all health care levels across the country within the Universal Coverage Scheme. For the 134,038 patients hospitalized with cirrhosis, the overall 30‐day readmission rate was 17%. Common causes of readmission consisted of complications of portal hypertension (47%) and infections (17%). After adjusting for multiple covariates, predictors of 30‐day readmission included hepatocellular carcinoma (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.84‐2.06), human immunodeficiency virus–related admission (OR 1.81, 95% CI 1.51‐2.17) and cholangiocarcinoma (OR 1.64, 95% CI 1.3‐2.05). In all, 2,936 deaths (13%) occurred during readmission, and an additional 14,425 deaths up to 1 year (63.5% total mortality among readmitted patients). Causes of death were mostly from liver‐related mortality. Average cost at index admission for those with a 30‐day readmission were significantly higher than those readmitted beyond 30 days or not readmitted. Conclusions: Patients hospitalized with cirrhosis complications had high rates of unscheduled 30‐day readmission. Average hospitalization costs were high, and only 36.5% of patients readmitted within 30 days survived at 1 year.

show abstract

“…However, we used instead well-validated and widely accepted cirrhosis severity classification criteria: the Baveno criteria. The Baveno criteria have been previously used for the stratification of liver cirrhosis severity using administrative databases 35 , 36 . Fourth, since NRD captures only in-hospital mortality, the 30-day and calendar-year mortality we report might be an underestimate of the true mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Thirty-day readmission rates, trends and its impact on liver transplantation recipients: a national analysis

Mumtaz

Lee-Allen

Porter

et al. 2020

Sci Rep

Self Cite

View full text Add to dashboard Cite

Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. A retrospective study was performed using the Nationwide Readmissions Database from 2010 to 2014. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). Our secondary aims were to determine the trends of LT, reasons for readmission, costs and predictors of calendar year mortality. Multivariable logistic regression and Cox proportional hazards models were utilized. The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7–17.8%, p < 0.001) and decreased in 40–64 years (78.0–73.5%, p = 0.001) during study period. The majority of 30-day readmissions were due to post transplant complications, with packed red blood cell transfusions being the most common intervention during readmission. Medicaid or Medicare insurance, surgery at low and medium volume centers, infections, hemodialysis, liver biopsy, and length of stay > 10 days were the predictors of 30-day readmission. Moreover, number of early readmission, age > 64 years, non-alcoholic cirrhosis, and length of stay > 10 days were significant predictor of calendar year mortality in LTRs. Approximately one third of patients require early admission after LT. Early readmission not only increases burden on healthcare, but is also associated with calendar year mortality. Strategies should be implemented to reduce readmission in patients with high risk of readmission identified in our study.

show abstract

Early Readmission Predicts Increased Mortality in Cirrhosis Patients After Clostridium difficile Infection

Cited by 10 publications

References 36 publications

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Thirty‐Day Readmission and Cost Analysis in Patients With Cirrhosis: A Nationwide Population‐Based Data

Thirty-day readmission rates, trends and its impact on liver transplantation recipients: a national analysis

Contact Info

Product

Resources

About