Department of Medicine, University of South Dakota, Vermillion, SD, USA.
Avera Transplant Institute and McKennan University Hospital, Sioux Falls, SD, USA.
Alcohol Alcohol. 2022 Sep 10;57(5):576-580. doi: 10.1093/alcalc/agac015.
Readmission is frequent among patients with cirrhosis and is a complex multifactorial process. To examine the association of alcohol use disorder (AUD) and risk of readmission in patients with alcohol-associated cirrhosis.
National Readmission Dataset (2016-2017) was used to extract a retrospective cohort of 53,348 patients with primary or secondary discharge diagnosis code of alcohol-associated cirrhosis with their first admission (26,674 patients with vs. propensity matched 26,674 without a primary or secondary discharge diagnosis code of AUD). Readmission within 30-day was lower (43.9 vs. 48%, P < 0.001) among patients identified to have AUD at the time of discharge. In a conditional logistic regression model, a diagnosis of AUD was associated with 15% reduced odds of 30-day readmission, 0.85 (0.83-0.88). Furthermore, the reason for readmission among patients identified vs. not identified to have AUD was less likely to be liver disease complication. The findings remained similar in a matched cohort of patients where the AUD diagnosis at discharge was listed as one of the secondary diagnoses only.
Although, our study findings suggest that identification of AUD at the time of discharge among patients hospitalized for alcohol-associated cirrhosis reduces the risk of 30-day readmission, unavailable information on patient counseling, referral for mental health specialist and treatment received for AUD limit the causality assessment. Future studies are needed overcoming the inherent limitations of the database to establish the role of identification and treatment of AUD in reducing readmission and liver decompensation in patients with alcohol-associated cirrhosis.
肝硬化患者的再入院率较高，且其是一个复杂的多因素过程。本研究旨在探讨酒精使用障碍（AUD）与酒精性肝硬化患者再入院风险的相关性。
本研究使用国家再入院数据库（2016-2017 年）提取了一个包含 53348 例原发性或继发性出院诊断为酒精性肝硬化的患者的回顾性队列，其中 26674 例患者（有 AUD 诊断）与倾向得分匹配的 26674 例患者（无 AUD 诊断）。有 AUD 诊断的患者出院时 30 天内再入院率更低（43.9% vs. 48%，P<0.001）。在条件逻辑回归模型中，AUD 诊断与 30 天内再入院的可能性降低 15%相关，比值比为 0.85（0.83-0.88）。此外，与未识别出 AUD 的患者相比，识别出 AUD 的患者的再入院原因更不可能是肝脏疾病并发症。在仅将 AUD 诊断列为次要诊断之一的出院患者匹配队列中，研究结果仍然相似。
尽管我们的研究结果表明，在因酒精性肝硬化住院的患者中，出院时识别 AUD 可降低 30 天内再入院的风险，但患者咨询、心理健康专家转诊和 AUD 治疗的信息不可用，限制了因果关系的评估。需要未来的研究克服数据库的固有局限性，以确定识别和治疗 AUD 在降低酒精性肝硬化患者的再入院率和肝功能失代偿方面的作用。
