Young, Female, and Medicaid Populations With Acute Alcoholic Hepatitis Are at Increased Risk of Readmission

Abstract

Introduction: Acute alcoholic hepatitis (AAH) is found in patients with heavy alcohol use and often requires hospitalization. We studied the 30-day readmission in hospitalized patients with AAH using the 2014 National Readmission Database. Methods: This is a retrospective cohort study using the 2014 National Readmission Database. We included non-elective hospitalizations with a primary diagnosis ICD-9 code indicating AAH and age equal to or above 18. Readmission was defined as the first admission to hospital for any non-trauma cause within 30 days of the index admission. The primary outcome was the 30-day readmission rate. Secondary outcomes included mortality rate, causes for readmission, healthcare cost, and readmission risk factors that were identified using multivariate regression analysis. Results: The total number of admissions for AAH was 13,418. The mean age was 46.7 (46.4-47.0), 40.1% were female, and 33.4% had alcoholic cirrhosis. The in-hospital mortality rate was 3.3% while all-cause 30-day mortality rate after discharge was 1.5%. The all-cause and AAH-specific 30-day readmission rate was 20.9% and 3.4%, respectively. The in-hospital mortality rate for readmitted patients was 8.5%. The mean length of stay for readmission was 6.1 days and the mean cost for readmission was $12,603. The top causes for readmission were (1-5): AAH, Alcoholic cirrhosis, Hepatic encephalopathy, Alcohol withdrawal, and Unspecified septicemia. Various risk factors were tested using univariate and multivariate regression analysis. The odds ratios (ORs) and p-values were calculated using multivariable logistic regression and independent predictors for readmission were identified as shown in Table 1: Medicaid (OR 1.29; 1.06-1.56) with private insurance as reference, female sex (OR 1.168; 1.004-1.360), younger age (OR 0.992; 0.985-0.998), higher Charlson comorbidity score after adjusting for multiple clinical comorbidities (cirrhosis, hepatic encephalopathy, coagulopathy, chronic kidney disease/failure, diabetes, deficiency anemia, and failure to thrive), rehab transfer status, and hospital characteristics. Conclusion: AAH had a high 30-day readmission rate of 20.9% and readmitted patients had a high mortality rate of 8.5%. Readmission was mostly for alcohol related comorbidities. Medicaid insured, female sex, younger age, and increased comorbidities are predictors of readmission; this indicates young, female, and Medicaid populations should be targeted for better intervention to prevent readmissions.953 Figure 1 No Caption available.