Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort

Patel, Ruchir; Poddar, Prateik; Choksi, Dhaval; Pandey, Vikas; Ingle, Meghraj; Khairnar, Harshad; Sawant, Prabha

doi:10.5604/01.3001.0012.7859

Cited by 12 publications

(21 citation statements)

References 24 publications

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“…Readmission among patients with AD cirrhosis in the current study was common, with incidence rates of 24.6, 43.0, and 51.8% at 30, 60, and 90 days, respectively. This finding was similar to that obtained from earlier studies based in India and North America (10,16,18). The etiology of cirrhosis in India was mainly hepatitis B virus (50.4%), while in North America and Europe, the main causes of cirrhosis were alcohol consumption (29.4%) and HCV (39.3%) (10,11).…”

Section: Discussionsupporting

confidence: 90%

“…The etiology of cirrhosis in India was mainly hepatitis B virus (50.4%), while in North America and Europe, the main causes of cirrhosis were alcohol consumption (29.4%) and HCV (39.3%) (10,11). We identified bacterial infection as the main reason for index admission and readmission (54.3% at initial admission, 44.7% at 30 days, 48.2% at 60 days, and 48.9% at 90 days), distinct from findings from India, North America, and Europe, where hepatic encephalopathy and ascites were identified as the main contributory factors (10,11,16,18,36). This difference may be associated with the distinct inclusion/exclusion criteria and medical conditions in different regions.…”

Section: Discussionmentioning

confidence: 88%

“…INR and TB are critical markers of liver protein synthesis function and the extent of hepatocellular necrosis (23,43). These three indicators are all or partly involved in the construction of CLIF-C ADs, MELD-Nas, MELDs, and CTPs, reported to be significantly associated with the prognosis of AD cirrhosis or readmission (6,11,16,18,31,36). However, owing to the involvement of the logarithm in calculations of MELDs, MELD-Nas, and CLIF-C ADs, clinicians have to use calculators, making it impractical in busy clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…An estimated 27.1% of readmissions may be avoidable (5). To date, several studies have focused on assessing the predictors of readmission in decompensated cirrhosis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, hospital readmission rates of patients with cirrhosis remain high, ranging from 10 to 50%, with a pooled estimate of 26% at 30 days and 21-71% at 90 days (19).…”

Section: Introductionmentioning

confidence: 99%

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Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

Tan

Wang

et al. 2021

Front. Med.

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Background and Aims: Patients with acute decompensated (AD) cirrhosis are frequently readmitted to the hospital. An accurate predictive model for identifying high-risk patients may facilitate the development of effective interventions to reduce readmission rates.Methods: This cohort study of patients with AD cirrhosis was conducted at six tertiary hospitals in China between September 2012 and December 2016 (with 705 patients in the derivation cohort) and between January 2017 and April 2020 (with 251 patients in the temporal validation cohort). Least absolute shrinkage and selection operator Cox regression was used to identify the prognostic factors and construct a nomogram. The discriminative ability, calibration, and clinical net benefit were evaluated based on the C-index, area under the curve, calibration curve, and decision curve analysis. Kaplan–Meier curves were constructed for stratified risk groups, and log-rank tests were used to determine significant differences between the curves.Results: Among 956 patients, readmission rates were 24.58, 42.99, and 51.78%, at 30, 60, and 90 days, respectively. Bacterial infection was the main reason for index hospitalization and readmission. Independent factors in the nomogram included gastrointestinal bleeding [hazard rate (HR): 2.787; 95% confidence interval (CI): 2.221–3.499], serum sodium (HR: 0.955; 95% CI: 0.933–0.978), total bilirubin (HR: 1.004; 95% CI: 1.003–1.005), and international normalized ratio (HR: 1.398; 95% CI: 1.126–1.734). For the convenience of clinicians, we provided a web-based calculator tool (https://cqykdx1111.shinyapps.io/dynnomapp/). The nomogram exhibited good discrimination ability, both in the derivation and validation cohorts. The predicted and observed readmission probabilities were calibrated with reliable agreement. The nomogram demonstrated superior net benefits over other score models. The high-risk group (nomogram score >56.8) was significantly likely to have higher rates of readmission than the low-risk group (nomogram score ≤ 56.8; p < 0.0001).Conclusions: The nomogram is useful for assessing the probability of short-term readmission in patients with AD cirrhosis and to guide clinicians to develop individualized treatments based on risk stratification.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

Tan

Wang

et al. 2021

Front. Med.

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“…Our outcomes may also have been a reflection of the high mean MELD-Na score at admission in our cohort, which in itself has been associated with higher readmission rates, although a significant difference was not observed between the two study groups. [26][27][28] On a positive note, we observed higher rates of rifaximin use in the order set group. Although not a specific outcome of our study, rates of rifaximin use were high in both groups but significantly higher in the order set group.…”

Section: Discussionmentioning

confidence: 61%

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

Olson

Wang

et al. 2021

BMJ Open Gastroenterol

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ObjectiveWe evaluated the effect on clinical outcomes of implementing a standardised inpatient order set for patients admitted with hepatic encephalopathy (HE).MethodsA retrospective review of patients with cirrhosis admitted with HE. Hospital admissions for HE for which the electronic health record (EHR) order set was used were compared with admissions where the order set was not used. Primary outcome was length of hospital stay (LOS). Secondary outcomes were 30-day readmissions, in-hospital complications, in-hospital and 90-day mortality.ResultsThere were 341 patients with 980 admissions over the study period: 263 patients with 736 admissions where the order set was implemented, and 78 patients with 244 admissions where the order set was not implemented. Median LOS was 4 days (IQR 3–8) in the order set group compared with 3 days (IQR 2–7) (p<0.001); incidence rate ratio 1.37 (95% CI 1.20 to 1.57), p<0.001. 30-day readmissions rate was 56% in the order set group compared with 40%, p=0.01; OR for readmission was 1.88 (95% CI 1.04 to 3.43), p=0.04. Hypokalaemia occurred in 46% of admissions with order set use compared with 36%, when the order set was not used; p=0.003, OR 1.72 (95% CI 1.22 to 2.43), p=0.002. No significant differences were seen for in-hospital mortality and 90-day mortality.ConclusionImplementation of an inpatient EHR order set for use in patients with HE was associated with unexpected clinical outcomes including increased LOS and readmissions. The convenience and advantages of standardisation of patient care should be balanced with a degree of individualisation, particularly in the care of medically complex patients. Furthermore, standardised processes should be evaluated frequently after implementation to assess for unintended consequences.

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A Comparison of Different Frailty Scores and Impact of Frailty on Outcome in Patients With Cirrhosis

Singh

Taneja

Tandon

et al. 2022

Journal of Clinical and Experimental Hepatology

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Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis: A Prospective Study in a Large Asian Cohort

Cited by 12 publications

References 24 publications

Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

Unexpected clinical outcomes following the implementation of a standardised order set for hepatic encephalopathy

A Comparison of Different Frailty Scores and Impact of Frailty on Outcome in Patients With Cirrhosis

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