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Early Hospital Readmissions and Mortality in Patients With Decompensated Cirrhosis Enrolled in a Large National Health Insurance Administrative Database

Scaglione, Steven J. MD*,†; Metcalfe, Leanne PhD; Kliethermes, Stephanie PhD; Vasilyev, Ivan MS; Tsang, Rebecca MD*; Caines, Allyce MD*; Mumtaz, Shaham MD*; Goyal, Vik MD*; Khalid, Asra MPH; Shoham, David PhD; Markossian, Talar PhD; Luke, Amy PhD; Underwood, Howard MD; Cotler, Scott J. MD*

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 839–844
doi: 10.1097/MCG.0000000000000826
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Background: Patients with decompensated cirrhosis have high rates of morbidity and mortality and frequently require hospital admission. Few studies have examined early readmission as an indicator of 90 day and overall mortality. Analysis of large databases is needed to evaluate the association between early readmission and mortality in decompensated cirrhosis.

Methods: We analyzed 5 years of private, employer-based, health insurance claims data associated with HealthCare Services Corporation on 13.5 million members over 4 states from 2010 to 2014. We defined early readmission as an admission to a general acute care hospital within 30 days of an index hospitalization and compared mortality to those who were readmitted after 30 days (late readmission). Univariable analysis was used to compare clinical and patient characteristics associated with early readmission. Cox proportional hazard models with time-varying covariates were used to assess if an early readmission was an independent risk factor for death.

Results: A total of 16,107 patients with decompensated cirrhosis were analyzed. During the study period, 82% of patients with decompensated cirrhosis were hospitalized at least once. Over 50% of hospitalized patients experienced an early readmission. Patients with an early readmission received blood transfusions, transjugular intrahepatic portosystemic shunt, paracentesis, thoracentesis, and upper endoscopies more frequently than those with a late readmission. Cirrhotics with an early readmission had higher rates of hepatorenal syndrome, sepsis, hepatocellular carcinoma, hepatic encephalopathy, and ascites. Patients experiencing an early readmission had greater 90 day, 1 year and overall mortality. Early readmission was an independent predictor of worse survival when adjusting for other conditions associated with mortality in patients with cirrhosis, but the impact of an early readmission dissipated after 1 year.

Conclusions: Patients with decompensated cirrhosis have high rates of hospitalization and frequently experience an early readmission. An early readmission to an acute care hospital is an independent predictor of mortality in patients with decompensated cirrhosis for at least 1 year following initial hospitalization.

*Department of Internal Medicine, Division of Hepatology, Loyola University Medical Center

Department of Preventive Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL

Health Care Services Corporation, Chicago, IL

S.J.S. was involved in the study concept and design, decisions on analysis and interpretation of data, drafting of manuscript, critical revision of manuscript for important intellectual content, and study supervision. L.M., S.K., and I.V. were involved in the study concept and design, decisions on analysis and interpretation of data, drafting of manuscript, critical revision of manuscript for important intellectual content and study supervision. R.T. was involved in analysis and interpretation of data and critical revision of manuscript for important intellectual content. A.C., S.M., D.S., and T.M. were involved in interpretation of data and critical revision of manuscript for important intellectual content. A.K. was involved in decision on analysis, reanalysis and interpretation of data as well as manuscript revisions. A.L. was involved in study concept and design, interpretation of data, critical revision of manuscript for important intellectual content, and study supervision. H.U. and S.J.C. were involved in study concept and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript for important intellectual content, and study supervision.

The authors declare that they have nothing to disclose.

Address correspondence to: Steven J. Scaglione, MD, Department of Internal Medicine, Division of Hepatology, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153 (e-mail: stevescaglione@gmail.com).

Received August 5, 2016

Accepted January 23, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.