Hospital readmissions among patients with decompensated cirrhosis.
Hospital readmissions among patients with decompensated cirrhosis.
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DOI：
10.1038/ajg.2011.314
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发表时间：
2012-02
影响因子：
9.8
通讯作者：
Lok, Anna S.
中科院分区：
文献类型：
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作者：
Volk, Michael L.;Tocco, Rachel S.;Bazick, Jessica;Rakoski, Mina O.;Lok, Anna S.
早期再住院在许多疾病状态中已得到很好的表征，但在肝硬化患者中并非如此。本研究的目的是确定失代偿期肝硬化患者再次入院的频率、费用、预测因素和可预防的原因。计算了402例肝硬化并发症之一后出院的患者的再入院率：腹水、自发性细菌性腹膜炎、肾衰竭、肝性脑病或静脉曲张出血。再次入院的费用使用医院会计系统计算。使用考克斯回归确定首次再入院时间的预测因子，使用负二项回归确定住院率/人年的预测因子。再入院率和死亡率之间的独立相关性采用考克斯回归分析。出院后30天内的入院情况由两名评审员进行评估，以确定是否可以预防。276例（69%）受试者至少有一次非择期再入院，至首次再入院的中位时间为67天。出院后1周，14%的受试者再次入院，37%的受试者在1个月内再次入院。一周内和1-4周之间再次入院的平均费用分别为28，898美元和20，581美元。在中位随访203天期间，再次入院的中位次数为2次（范围0-40），总住院率为3次/人-年。尽管调整了混杂因素，包括终末期肝病模型评分，但更频繁再入院的患者随后死亡的风险更高。首次再入院时间的预测因素包括MELD评分、血清钠和出院时的药物数量;住院率的预测因素包括这些变量以及肝硬化并发症的数量和出院时是否在移植名单上。在30天内再次入院的165人中，22%是可以预防的。失代偿期肝硬化患者再次入院是常见的，昂贵的，中等可预测的，在某些情况下可能是可以预防的，并与死亡率独立相关。这些发现支持疾病管理干预措施的发展，以防止再次住院。
Early re-hospitalizations have been well characterized in many disease states, but not among patients with cirrhosis. The aims of this study were to identify the frequency, costs, predictors, and preventable causes of hospital re-admissions among patients with decompensated cirrhosis. Rates of re-admission were calculated for 402 patients discharged after one of the following complications of cirrhosis: ascites, spontaneous bacterial peritonitis, renal failure, hepatic encephalopathy or variceal hemorrhage. Costs of re-admissions were calculated using the hospital accounting system. Predictors of time to first re-admission were determined using Cox regression, and predictors of hospitalization rate/person-years using negative binomial regression. The independent association between re-admission rate and mortality was determined using Cox regression. Admissions within 30 days of discharge were assessed by two reviewers to determine if preventable. 276 (69%) subjects had at least one non-elective re-admission, with a median time to first re-admission of 67 days. By one week after discharge 14% of subjects had been re-admitted, and 37% were re-admitted within one month. The mean costs for re-admissions within one week and between weeks 1–4 were $28,898 and %20,581, respectively. During a median follow-up of 203 days, the median number of re-admissions was 2 (range 0–40), with an overall rate of 3 hospitalizations/person-years. Patients with more frequent re-admissions had higher risk of subsequent mortality, despite adjustment for confounders including the Model for End-stage Liver Disease score. Predictors of time to first re-admission included MELD score, serum sodium, and number of medications on discharge; predictors of hospitalization rate included these variables as well as the number of cirrhosis complications and being on the transplant list at discharge. Among 165 re-admissions within 30 days, 22% were possibly preventable. Hospital re-admissions among patients with decompensated cirrhosis are common, costly, moderately predictable, in some cases possibly preventable, and independently associated with mortality. These findings support the development of disease management interventions to prevent re-hospitalization.
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RAWAL, J;BARNETT, P;LLOYD, BW
通讯作者：
LLOYD, BW