Readmission in Cirrhosis.

摘要

Background: Patients with cirrhosis are susceptible to a variety of complications, have high rates of disability and health care utilization, and often require re-hospitalization. Patients who survive their hospitalization are at high risk for readmissions which has negative consequences for both the patient and the health care system. Recent studies in cirrhotics have suggested a high rate of readmission within 1 month of discharge. However, these studies have been carried out in single center institutions or on data from tertiary-care referral centers. There are no epidemiological studies to date that have been carried out in the community.;Methods: We analyzed data from patients resident in Minnesota, Iowa and Wisconsin with cirrhosis who were hospitalized to a Mayo Clinic hospital from January 1, 2010 to January 1, 2014. Hospitalized cirrhotics were selected from MCLSS/DDQB, a query tool to provide research access to Rochester clinical data in a single centralized database. Data were manually reviewed by the authors. Patients with elective admission, recipients of liver transplants, and patients resident outside the area of interest were not included. Univariate and multivariate Cox models analyses were used to identify variables to predict time to 30-day readmission. Data were analyzed using SAS version 9 and R for graphic creation.;Results: Of the 2,077 patients hospitalized with complications of cirrhosis, 527 (25%) subjects had 30-day readmission at Mayo Clinic hospital and 157 (8%) had 30-day readmission in community hospitals within Mayo Clinic Health Systems. After adjusting for multiple covariates, predictors of time to 30-day readmission included duration of initial hospitalization, the Model for End-stage Liver Disease (MELD) score, serum sodium, serum aspartate aminotransferase (AST), white blood cells count and platelets count. Common causes of readmission both of tertiary care hospitals and community hospitals were infections and complications of portal hypertension.;Conclusions: Since patients hospitalized with cirrhosis have a 30 day re-admission risk of 31.7%, risk factors for 30-day readmission should be targeted to develop strategies to reduce readmission rates.