Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Hepatol. 2019 Mar-Apr;18(2):310-317. doi: 10.1016/j.aohep.2018.08.001. Epub 2019 Apr 17.
Hepatic encephalopathy (HE) is a common complication in cirrhotics and is associated with an increased healthcare burden. Our aim was to study independent predictors of 30-day readmission and develop a readmission risk model in patients with HE. Secondary aims included studying readmission rates, cost, and the impact of readmission on mortality.
We utilized the 2013 Nationwide Readmission Database (NRD) for hospitalized patients with HE. A risk assessment model based on index hospitalization variables for predicting 30-day readmission was developed using multivariate logistic regression and validated with the 2014 NRD. Patients were stratified into Low Risk and High Risk groups. Cox regression models were fit to identify predictors of calendar-year mortality.
Of 24,473 cirrhosis patients hospitalized with HE, 32.4% were readmitted within 30 days. Predictors of readmission included presence of ascites (OR: 1.19; 95% CI: 1.06-1.33), receiving paracentesis (OR: 1.43; 95% CI: 1.26-1.62) and acute kidney injury (OR: 1.11; 95% CI: 1.00-1.22). Our validated model stratified patients into Low Risk and High Risk of 30-day readmissions (29% and 40%, respectively). The cost of the first readmission was higher than index admission in the 30-day readmission cohort ($14,198 vs. $10,386; p-value <0.001). Thirty-day readmission was the strongest predictor of calendar-year mortality (HR: 4.03; 95% CI: 3.49-4.65).
Nearly one-third of patients with HE were readmitted within 30 days, and early readmission adversely impacted healthcare utilization and calendar-year mortality. With our proposed simple risk assessment model, patients at high risk for early readmissions can be identified to potentially avert poor outcomes.
肝性脑病（HE）是肝硬化患者常见的并发症，与医疗保健负担增加有关。我们的目的是研究肝性脑病患者 30 天再入院的独立预测因素，并建立再入院风险模型。次要目的包括研究再入院率、成本以及再入院对死亡率的影响。
我们利用 2013 年全国再入院数据库（NRD）对住院的肝性脑病患者进行了研究。使用多元逻辑回归建立了基于索引住院变量的预测 30 天再入院的风险评估模型，并使用 2014 年 NRD 进行了验证。患者分为低风险和高风险组。使用 Cox 回归模型确定日历年度死亡率的预测因素。
在 24473 例因 HE 住院的肝硬化患者中，32.4%在 30 天内再次入院。再入院的预测因素包括腹水存在（OR：1.19；95%CI：1.06-1.33）、接受腹腔穿刺术（OR：1.43；95%CI：1.26-1.62）和急性肾损伤（OR：1.11；95%CI：1.00-1.22）。我们验证的模型将患者分为低风险和高风险 30 天再入院组（分别为 29%和 40%）。在 30 天再入院组中，第一次再入院的费用高于索引入院（14198 美元比 10386 美元；p 值<0.001）。30 天再入院是日历年度死亡率的最强预测因素（HR：4.03；95%CI：3.49-4.65）。
近三分之一的肝性脑病患者在 30 天内再次入院，早期再入院对医疗保健的利用和日历年度死亡率产生不利影响。使用我们提出的简单风险评估模型，可以识别出早期再入院风险较高的患者，从而有可能避免不良结局。
