Section of Gastroenterology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC, 29425, USA.
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Dig Dis Sci. 2019 Jun;64(6):1470-1477. doi: 10.1007/s10620-019-5459-3. Epub 2019 Jan 23.
Patients hospitalized for cirrhosis are at high risk for readmission and death for the first 30 days following discharge. However, there is no information on how these risks dynamically change over a full year after discharge. Our aim was to determine the absolute risks of first readmission and death and characterize these changes in the first year following hospital discharge.
We conducted a retrospective cohort study of patients who were hospitalized with cirrhosis at all Veterans Affairs hospitals and discharged home between 01/01/2010 and 12/31/2013. We used separate survival models to determine risk of first readmission and death after hospital discharge. We also examined the absolute daily risks for first readmission and death by day and identified the time required for risks of readmission and death to decline 50% and 75% from maximum values.
Of the 38,955 patients who survived index hospitalization for cirrhosis, 23,318 patients (59.9%) had at least one readmission and 11,567 patients (29.7%) died within the first year. Daily risk of readmission was the highest on day 1 (1.23%) and declined 50% by day 71 and 75% by day 260. After 1 year, daily risk of readmission did not plateau. Daily risk of death was the highest on day 1 (0.78%) and declined 50% by day 31 and 75% by day 64.
The risk of readmission and death after cirrhosis-related hospitalization remains elevated for prolonged periods. Patients and providers should remain vigilant for clinical health deterioration beyond the first 30 days following hospitalization.
因肝硬化住院的患者在出院后 30 天内再次入院和死亡的风险很高。然而，关于这些风险在出院后整整一年如何动态变化的信息却并不存在。我们的目的是确定首次再入院和死亡的绝对风险，并描述出院后第一年的这些变化。
我们对所有退伍军人事务部医院因肝硬化住院且在 2010 年 1 月 1 日至 2013 年 12 月 31 日出院回家的患者进行了回顾性队列研究。我们使用单独的生存模型来确定出院后首次再入院和死亡的风险。我们还通过天来检查首次再入院和死亡的绝对每日风险，并确定再入院和死亡风险从最大值下降 50%和 75%所需的时间。
在因肝硬化住院而存活的 38955 名患者中，有 23318 名（59.9%）至少有一次再入院，11567 名（29.7%）在出院后的第一年死亡。再入院的每日风险在第 1 天最高（1.23%），第 71 天下降 50%，第 260 天下降 75%。1 年后，再入院的每日风险并未趋于平稳。死亡的每日风险在第 1 天最高（0.78%），第 31 天下降 50%，第 64 天下降 75%。
肝硬化相关住院后再入院和死亡的风险在很长一段时间内仍然很高。患者和医务人员应保持警惕，注意住院后 30 天内临床健康状况恶化的情况。
