Predictors of In-Hospital Mortality and of 30-Day Readmissions in Hepatic Encephalopathy (From the Nationwide Readmissions Database)

Abstract

Introduction: Hepatic encephalopathy (HE) is a common complication of decompensated cirrhosis. Many patients experience repeated episodes of HE but sparse data are available describing trends, outcomes and predictors of 30-day readmission in HE population. This study aims at evaluating 30-day readmissions in patients readmitted with HE in a national sample of US population. Methods: The study cohort was derived from the National Readmission Database (NRD) 2010 to 2014, which is a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. Hepatic encephalopathy (HE) was identified using International Classification of Diseases (ICD 9 CM), 9th Revision code 572.2 in primary diagnosis field. We only included first admission of the year and excluded patients with missing information on age, gender, mortality, and age ≤18. The primary outcome was in hospital mortality and secondary outcome was 30-day readmissions. Hierarchical multivariable logistic regression was used to adjust for confounders. Results: In total, 135,550 patients with HE were included, of which 38058 (28.09%) patients were readmitted within 30 days. Readmitted patients were more likely to have co-morbidities like diabetes (41.27% vs. 38.15%), renal failure (23.69% vs. 18.02%), anemia (39.755 vs. 33. 72%) and drug abuse (6.56 vs. 5.96%). Mortality and length of stay in index admissions were 7.6% and 6.10±0.04 days respectively. Predictors of mortality during index admissions were age (OR 1.00, 95% CI 1.02 to 1.01, p = 0.006), female (OR 1.14, 95% CI 1.05 to 1.22, p < 0.001), congestive heart failure (OR 1.31, 95% CI 1.17 to 1.47, p <0.001), peripheral vascular disease (OR 1.42, 95% CI 1.17 to 1.72, p < 0.001), renal failure (OR 1.38, 95% CI 1.26 to 1.52, p <0.001), malignancy (OR 2.97, 95% CI 2.65 to 3.33, p <0.001), coagulopathy (OR 1.48, 95% CI 1.38 to 1.59, p <0.001) and alcohol abuse (OR 1.53, 95% CI 1.41 to 1.66, p <0.001). Predictors of increased readmissions were renal failure (OR 1.46, 95% CI 0.83 to 1.06, p <0.001), anemia (OR 1.26, 95% CI 1.20 to 1.31, p <0.001), Medicaid (OR 1.13, 95% CI 1.06 to 1.20, p <0.001) compared to Medicare, weekend admission (OR 1.06, 95% CI 1.01 to 1.11, p <0.001). Conclusion: Our study helps identifying high risk HE population for worse short-term outcomes including in hospital mortality and 30-day readmission. Targeted approach focusing on such a high-risk population can be rewarding.1003_A Figure 1. Multivariate Predictors of 30-day readmissions in Hepatic Encephalopathy1003_B Figure 2. Multivariate Predictors of in hospital mortality in Hepatic Encephalopathy