Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis.
Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis.
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DOI：
10.1016/j.cgh.2019.04.048
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发表时间：
2020-02
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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因酒精性肝炎(AH)入院的患者再次入院和死亡的风险增加。我们的目标是确定与再次入院、酗酒和死亡率相关的因素。我们对1999-2016年间连续入院的急性肝炎患者进行了回顾性分析(测试队列，n=135)。我们在2013年至2017年对多中心AH研究联盟的患者进行的前瞻性分析中验证了我们的发现(验证队列，n=159)。酒精复发被定义为出院后30天内的任何饮酒量。早期酒精康复被定义为出院后30天内住院或门诊成瘾治疗或相互支持小组参与。两组患者30天的再住院率均为30%。酒精复发率在测试中为37%，在验证队列中为34%。出院后，测试队列中的27名患者(20%)和验证队列中的19名患者(16%)接受了早期酒精康复。中位随访期为2.8年，死亡53例(39%)；中位随访期1.3年，死亡42例(26%)。在测试队列中，早期酒精康复降低了30天再次住院(调整后的优势比[AOR]0.16；95%CI，0.04-0.65；P=.01)、30天酒精复发(AOR，0.11；95%CI，0.02-0.53；P<；.001)和死亡(调整后的风险比[AHR]，0.20；95%CI，0.05-0.56；P=.001)的风险。在验证队列中，早期酒精康复降低了30天再次住院(AOR，0.30；95%CI，0.09-0.98；P=0.04)、30天酒精复发(AOR 0.09；95%CI，0.01-0.73；P=0.02)和死亡(AHR，0.20；95%CI，0.01-0.94；P=0.04)的几率。一个结合酒精康复和胆红素的模型确定了30天内再次入院的患者，接收器操作特征曲线下的面积为0.73。在对两组住院的急性肝炎患者的分析中，早期酒精康复可以降低再次住院、酒精复发和死亡的风险，应该被视为急性肝炎住院治疗的质量指标。
Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n=135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n=159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P=.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P<.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P=.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P=.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P=.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P=.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.
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影响因子：
9.8
作者：
Dominguez, Marlene;Rincon, Diego;Bataller, Ramon
通讯作者：
Bataller, Ramon
DOI：
10.1016/j.mayocpiqo.2017.04.004
发表时间：
2017-07
期刊：
Mayo Clinic proceedings. Innovations, quality & outcomes
影响因子：
--
作者：
Lourens S;Sunjaya DB;Singal A;Liangpunsakul S;Puri P;Sanyal A;Ren X;Gores GJ;Radaeva S;Chalasani N;Crabb DW;Katz B;Kamath PS;Shah VH;TREAT Consortium
通讯作者：
TREAT Consortium
DOI：
10.1016/j.amjmed.2016.10.004
发表时间：
2017-02
期刊：
The American journal of medicine
影响因子：
--
作者：
Leggio L;Lee MR
通讯作者：
Lee MR
影响因子：
13.5
作者：
Aberg, Fredrik;Helenius-Hietala, Jaana;Jula, Antti
通讯作者：
Jula, Antti
影响因子：
4.6
作者：
Weinrieb, Robert M.;Van Horn, Deborah H. A.;Lucey, Michael R.
通讯作者：
Lucey, Michael R.