Low haemoglobin level predicts early hospital readmission in patients with cirrhosis and acute decompensation

Pompili, Enrico; Baldassarre, Maurizio; Zaccherini, Giacomo; Tufoni, Manuel; Iannone, Giulia; Pratelli, Dario; Palmese, Francesco; Vizioli, Luca; Faggiano, Chiara; Bedogni, Giorgio; Domenicali, Marco; Caraceni, Paolo

doi:10.1016/j.jhepr.2023.100698

Cited by 4 publications

(7 citation statements)

References 48 publications

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“…All together, these findings are consistent with previous several studies showing that ACLF is more common in patients with more advanced liver disease and a higher degree of systemic inflammation 4,5 . Furthermore, low haemoglobin levels, which have been already correlated to the development of ACLF both patients with AD and in those with SDC, may be expression of both severity of cirrhosis and chronic inflammation 6,23–25 . Thus, it could be expected that, in the near future, novel biomarkers related to inflammation or oxidative stress, either alone or integrated into the current prognostic scores, might be able to predict the development of ACLF and reach the daily clinical levels.…”

Section: Discussionsupporting

confidence: 89%

“…4,5 Furthermore, low haemoglobin levels, which have been already correlated to the development of ACLF both patients with AD and in those with SDC, may be expression of both severity of cirrhosis and chronic inflammation. 6,[23][24][25] TA B L E 2 (Continued) laboratory features when admitted to hospital. 3 In our study, the only difference was that HE was more likely associated with UDC than SDC.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, it is already known that early readmission increases the risk of mortality. 25,29 Finally, these results prompt the execution of prospective studies aiming to identify predictors useful to discriminate between the UDC and SDC phenotypes at the time of discharge rather than at admission of the index hospital admission, in the pragmatic perspective of defining more accurately the type and intensity of the outpatient follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Whether this change of trajectory will automatically produce an improvement in survival remains unclear, as the need of hospitalization varies according to multiple factors not strictly related to the severity of disease, such as family support, socio‐economic status, healthcare organization and available outpatient services. Nevertheless, it is already known that early readmission increases the risk of mortality 25,29 …”

Section: Discussionmentioning

confidence: 99%

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Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study

Pompili,

Baldassarre,

Bedogni

et al. 2023

Liver International

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Background and AimsThe PREDICT study recently showed that acutely decompensated (AD) patients with cirrhosis can present three different clinical phenotypes in the 90 days after admission: (1) pre‐ACLF, developing acute‐on‐chronic liver failure (ACLF); (2) unstable decompensated cirrhosis (UDC), being re‐admitted for AD without ACLF and (3) stable decompensated cirrhosis (SDC), not presenting readmission or ACLF. This study aimed to externally validate the existence of these three distinct trajectories and to identify predictors for the occurrence of each trajectory.MethodsBaseline data, 3‐month ACLF and readmission incidence and 1‐year survival were analysed in a prospective cohort of patients admitted for AD. A multinomial multivariable model was used to evaluate the association between baseline features and clinical trajectories.ResultsOf the 311 patients enrolled, 55% met the criteria for SDC, 18% for UDC and 27% for pre‐ACLF, presenting a significantly different 1‐year mortality: pre‐ACLF 65%, UDC 46%, SDC 21% (p < .001). The presence of hepatic encephalopathy (HE) was associated with UDC (p = .043), while the absence of ascites to SDC (p = .017). Among laboratory parameters, an increase in MELD‐Na (p = .001) and C‐reactive protein (p = .009) and a decrease in haemoglobin (p = .004) and albumin (p = .008) levels were associated with pre‐ACLF.ConclusionThe present study confirms that AD patients have three different clinical trajectories with different mortality rates. Besides the severity of cirrhosis, the association with C‐reactive protein supports the predominant role of systemic inflammation in ACLF pathophysiology. Finally, HE is associated with the UDC phenotype highlighting the need for better management of this complication after discharge.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study

Pompili,

Baldassarre,

Bedogni

et al. 2023

Liver International

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“…In outpatient settings, four simple predictors of EASL‐ACLF were identified: MELD score, ascites, mean arterial pressure, and hemoglobin level 37 . Anemia has also been recognized as a marker for a higher risk of developing nosocomial ACLF in patients recently discharged from hospitalization for AD 38 . However, further research is needed to validate these findings and enable clinicians to effectively assess outpatient risk for developing EASL‐ACLF.…”

Section: Clinical Implicationmentioning

confidence: 99%

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

Xu,

Chen,

Artru

2024

UEG Journal

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It is essential to identify the subgroup of patients who experience poorer outcomes in order to adapt clinical management effectively. In the context of liver disease, the earlier the identification occurs, the greater the range of therapeutic options that can be offered to patients. In the past, patients with acute decompensation (AD) of chronic liver disease were treated as a homogeneous group, with emphasis on identifying those at the highest risk of death. In the last 15 years, a differentiation has emerged between acute‐on‐chronic liver failure syndrome (ACLF) and AD, primarily due to indications that the latter is linked to a less favorable short‐term prognosis. Nevertheless, the definition of ACLF varies among the different knowledge societies, making it challenging to assess its true impact compared with AD. Therefore, the purpose of this review is to provide a detailed analysis emphasizing the critical importance of identifying ACLF in the field of advanced liver disease. We will discuss the differences between Eastern and Western approaches, particularly in relation to the occurrence of liver failure and disease onset. Common characteristics, such as the dynamic nature of the disease course, will be highlighted. Finally, we will focus on two key clinical implications arising from these considerations: the prevention of ACLF before its onset and the clinical management strategies once it develops, including liver transplantation and withdrawal of care.

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A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

Kalo,

Baig,

Gregg

et al. 2023

BMC Gastroenterol

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Objective Delivering effective secondary preventive and integrated care has the potential to break the revolving-door phenomenon of frequent readmissions in patients with advanced chronic liver disease. To address this, we launched the Care Coordination of Liver Disease (CCoLD) pilot, a novel nurse-led cirrhosis clinic in Western Sydney. Methods and analysis Following an index presentation to Blacktown or Mount Druitt hospitals (BMDH), patients (n = 89, matched by age, sex, and MELD-NA) were consecutively either followed up by the CCoLD clinical nurse consultant (intervention cohort) or received standard care (control cohort). Controlled evaluation of the impact of the nurse-led clinic was carried out for a 3-month period including readmission rates, survival, and cost effectiveness. Results The inaugural nurse-led clinic led to improvement in patient-level outcomes including a reduction in unplanned liver-related readmissions (2.08% for intervention cohort vs 12.2% for control cohort, p < 0.01), and mortality at 30 days (0% for intervention cohort vs 7.3% for control cohort, p = 0.03). Similar trends were observed at 90 days from index discharge. No deaths were observed in the intervention cohort as compared to the control cohort at 90 days (0% versus 7.3%, p = 0.03), while unplanned liver-related readmissions were 10.41% for the intervention cohort vs 19.5% for the control cohort (p = 0.115). Moreover, time to readmission was significantly longer in the intervention cohort, resulting in an overall cost-effective intervention. Conclusion These findings highlight the significant impact of optimised care-coordination. A nurse-led clinic can deliver patient-centred, goal-directed, and cost-effective secondary prevention and care. A multicentre randomised trial for wider evaluation of these findings is warranted.

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Low haemoglobin level predicts early hospital readmission in patients with cirrhosis and acute decompensation

Cited by 4 publications

References 48 publications

Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study

Predictors of clinical trajectories of patients with acutely decompensated cirrhosis. An external validation of the PREDICT study

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

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