The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis.
The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis.
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DOI：
10.1002/hep.28414
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发表时间：
2016-07
期刊：
影响因子：
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通讯作者：
North American Consortium for the Study of End-Stage Liver Disease
中科院分区：
文献类型：
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作者：
Bajaj JS;Reddy KR;Tandon P;Wong F;Kamath PS;Garcia-Tsao G;Maliakkal B;Biggins SW;Thuluvath PJ;Fallon MB;Subramanian RM;Vargas H;Thacker LR;O'Leary JG;North American Consortium for the Study of End-Stage Liver Disease
在较小的单中心研究中，癫痫患者的再入院风险较高，但缺乏多中心前瞻性研究。采用前瞻性14中心NACSELD（北美终末期肝病研究联盟）队列，评价急性胰腺炎住院患者3个月再入院的决定因素。因非选择性适应症住院的肝硬化患者同意出院并随访3个月。计算3个月再入院的数量及其指数入院和出院的决定因素。我们对所有再入院、肝性脑病（HE）、肾/代谢和感染相关再入院使用多变量logistic回归。使用总样本的入院/出院变量制定评分，并在总人口的随机一半上进行验证。1353例患者入组，1177例患者出院时合格，1013例患者有3个月结局。53%（n=535;316例1例，219例≥2例）发生再入院，各研究中心的再入院率一致。主要原因为肝脏相关（n=333，HE、肾脏/代谢和感染）。MELD恶化的肝硬化患者、糖尿病患者、预防性使用抗生素的患者和既往HE患者更有可能再次入院。入院模型包括MELD和糖尿病（c统计量=0.64;分割验证后0.65）。出院模型包括MELD、质子泵抑制剂使用和较低的住院时间（c-统计量=0.65;分割验证后为0.70）。30%的再入院无法预测。肝脏相关再入院的患者始终有指标住院医院感染作为HE、肾脏/代谢和感染相关再入院的预测因子（OR 1.9-3.0）。大约一半的出院患者发生了三个月的再入院，这与肝硬化的严重程度、糖尿病和医院感染有关。密切监测晚期肿瘤和预防院内感染可以减轻这一负担。
In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-center perspective study is lacking. To evaluate the determinants of 3-month readmissions in cirrhotic inpatients using the prospective 14-center NACSELD (North American Consortium for the Study of End-Stage Liver Disease) cohort. Cirrhotics hospitalized for non-elective indications were consented and followed for 3-months post-discharge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions, and for hepatic encephalopathy (HE), renal/metabolic and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. 1353 patients were enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n=535;316 with one, 219 with ≥2), with consistent rates across sites. The leading causes were liver-related (n=333, HE, renal/metabolic and infections). Cirrhotics with worse MELD, diabetes, those taking prophylactic antibiotics and with prior HE, were more likely to be readmitted. The admission model included MELD and diabetes (c-statistic=0.64; after split-validation 0.65). The discharge model included MELD, proton pump inhibitor use and lower length-of-stay (c-statistic=0.65; after split-validation 0.70). 30% of readmissions could not be predicted. Patients with liver-related readmissions consistently had index-stay nosocomial infections as a predictor for HE, renal/metabolic and infection-associated readmissions (OR 1.9–3.0). Three-month readmissions occurred in about half of discharged cirrhotics, which were associated with cirrhosis severity, diabetes and nosocomial infections. Close monitoring of advanced cirrhotics and prevention of nosocomial infections could reduce this burden.