Predictors of 30-Day Readmission and Mortality in Patients With Decompensated Liver Cirrhosis: Analysis of Nationwide Readmission Data

Abstract

Introduction: Decompensated liver cirrhosis is reported to be the 12th leading cause of death in the U.S. with estimated deaths of 38,0000 annually. The readmission rate among patients with decompensated cirrhosis is estimated to be as high as 20-37% at 30 days in various single center studies. Information at a national level on 30-day readmission rate, its causes, predictors and mortality in patients with decompensated cirrhosis is lacking. Objectives: The aims of this study were to investigate the 30 day readmission rate, its causes and predictors and mortality in patients with decompensated liver cirrhosis. Methods: We utilized the Nationwide Readmission Database, Healthcare Cost and Utilization Project for a cross-sectional study of hospitalizations in the United States. Patients discharged with a primary diagnosis of decompensated liver cirrhosis in 2013 were included. Demographics, Elixhauser comorbidity scores, hospital characteristics, readmission rates and hospitalization outcomes were collected. Validated ICD-9 codes were used to capture patients. Multivariate logistic and linear regression models were fit to study the predictors of 30 day readmissions. Results: There were 39,913 patients admitted with a diagnosis of decompensated liver cirrhosis during the study period; of these 11,863 (30%) were readmitted at 30-days. Patients with low-income (OR: 1.08; CI: 1.01- 1.16), possessing medicaid (OR: 1.30 CI: 1.1-1.45) or Medicare (OR: 1.26; CI: 1.12-1.45) were more likely to readmit. On index admission, patients with Elixhauser comorbidity >3 (OR: 1.19; CI: 1.09-1.29) with hepatic encephalopathy (HE) (OR: 1.18; CI: 1.08-1.29), hepatorenal syndrome (HRS), (OR: 1.29; CI: 1.05-1.57), ascites (OR: 1.78; CI: 1.62-1.95) and hepatocellular carcinoma (HCC) (OR: 1.35; CI: 1.12-1.63) were more likely to be readmitted at 30-days. Moreover, patients discharged to home health care or left against medical advice were also more likely to be readmitted at 30-days (Table 1). In-hospital mortality was 2.7% and 9.4% at 30-days readmission and overall during 2013, respectively.Table: Table. Multivariate predictors of 30-day readmission in patients with decompensated liver cirrhosisConclusion: Approximately one third of patient with decompensated cirrhosis were readmitted with 30 days. Increased number of co-morbidity and presence of ascites, HRS, HCC and HE accounts for increased number of 30-days readmissions. A better understanding of predictors of 30-days readmission may guide strategies to decrease readmission among these patients.