Incidence and Risk Factors Associated With 30-Day Readmission for Alcoholic Hepatitis
Incidence and Risk Factors Associated With 30-Day Readmission for Alcoholic Hepatitis
复制标题
DOI：
10.1097/mcg.0000000000001202
复制
发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
Leise, Michael D.
中科院分区：
文献类型：
--
作者：
Garg, Sushil K.;Sarvepalli, Shashank;Leise, Michael D.
背景：酗酒和肝病与 30 天再入院率较高有关，但与酒精性肝炎 (AH) 和再入院相关的因素尚不清楚。我们的目的是确定 AH 患者 30 天再入院的发生率，并评估再入院的潜在预测因素。方法：我们使用全国再入院数据库来确定 2010 年至 2014 年间复发性 AH 的 30 天再入院率，并检查研究期间的再入院趋势。我们还确定了 20 个最常见的重新入院原因。使用多变量调查逻辑回归分析来确定与 30 天再入院相关的因素。结果：在 61,750 名因 AH 入院的患者中，23.9% 在 30 天内重新入院。研究期间再入院率没有显着变化。 AH、酒精性肝硬化和肝性脑病是再入院的最常见原因。在多变量分析中，女性、不遵守医疗建议、较高的查尔森合并症指数、腹水和减肥手术史与早期再入院相关，而年龄较大、付款人类型（私人或自费/其他）和出院到熟练护理机构则降低了这种风险。结论：研究期间AH患者30天再入院率较高且稳定。与再入院相关的因素可能有助于制定基于共识的专家指南、治疗算法和政策变化，以帮助减少 AH 的再入院。
Background: Alcohol abuse and liver disease are associated with high rates of 30-day hospital readmission, but factors linking alcoholic hepatitis (AH) to readmission are not well understood. We aimed to determine the incidence rate of 30-day readmission for patients with AH and to evaluate potential predictors of readmission. Methods: We used the Nationwide Readmissions Database to determine the 30-day readmission rate for recurrent AH between 2010 and 2014 and examined trends in readmissions during the study period. We also identified the 20 most frequent reasons for readmission. Multivariate survey logistic regression analysis was used to identify factors associated with 30-day readmission. Results: Of the 61,750 index admissions for AH, 23.9% were readmitted within 30-days. The rate of readmission did not change significantly during the study period. AH, alcoholic cirrhosis, and hepatic encephalopathy were the most frequent reasons for readmission. In multivariate analysis female sex, leaving against medical advice, higher Charlson comorbidity index, ascites, and history of bariatric surgery were associated with earlier readmissions, whereas older age, payer type (private or self-pay/other), and discharge to skilled nursing-facility reduced this risk. Conclusions: The 30-day readmission rate in patients with AH was high and stable during the study period. Factors associated with readmission may be helpful for development of consensus-based expert guidelines, treatment algorithms, and policy changes to help decrease readmission in AH.