Symptom Burden Is Associated with Increased Emergency Department Utilization Among Patients with Cirrhosis (SCI921)

Abstract

1.Describe the healthcare utilization of patients with cirrhosis.2.Interpret the association between symptom burden and health care utilization among patients with cirrhosis.3.Consider how palliative care co-management could help curb emergency department utilization in patients with cirrhosis. Patients with end-stage liver disease have significant morbidity and mortality, as well as substantial health care utilization. Despite this, few are referred to palliative care. How symptom burden impacts health care utilization in this population is unknown. To investigate the association of symptom burden with health care utilization among patients with cirrhosis. This prospective observational cohort study enrolled patients with cirrhosis undergoing outpatient liver transplantation evaluation from 7/1/19-9/30/19. Patients completed the Edmonton Symptom Assessment Scale (ESAS), a validated tool with total scores ranging 0-90 and higher scores indicating higher symptom burden. During 6 months of follow-up, emergency department (ED) visits, non-elective hospitalizations, total hospital days, intensive care unit (ICU) admissions, and 30-day readmissions were abstracted from the medical record. Of 233 patients (43% female, median age 61), the median total ESAS score was 16 (IQR 6-30). Over 6 months of follow-up, the mean (SD) total ED visits was 0.4 (1.2). Patients had mean (SD) 0.7 (1.4) hospitalizations, resulting in 3.3 (8.0) total hospital days and 0.4 (1.7) total ICU days. Hospital readmission rate within 30 days was 11%. Higher scores on the ESAS (per 5-point increase) were associated with increased ED visits (IRR=1.08, 95% CI 1.02-1.15, p=0.005), hospitalizations (IRR=1.08, 95% CI 1.02-1.13, p=0.01), total hospital days (IRR=1.06, 95% CI 1.01-1.10, p=0.01), total ICU days (IRR=1.08, 95% CI 1.00-1.16, p=0.04), and there was a trend towards increased 30-day readmissions (OR=1.02, 95% CI 1.00-1.04, p=0.06). After adjusting for age, sex, and MELDNa, ESAS remained an independent predictor of ED visits (IRR=1.07, 95% CI 1.01-1.13, p=0.03). Patient-reported symptoms are independently associated with ED visits, but not hospitalizations and ICU admissions, among patients with cirrhosis.