Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 13, Number 1, February 2020, pages 11-18


Risk Factors for Liver Cirrhosis-Related Readmissions in the Largest Ethnic Minority in United States

Figure

Figure 1.
Figure 1. Flowchart of patients included in the study.

Tables

Table 1. Baseline Demographic, Co-Morbid Conditions and Laboratory Parameters Stratified Between the Two Groups
 
VariablesPatients with no readmission (n = 104)Patients with readmission (n = 79)P-value
CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CHF: congestive heart failure; CAD: coronary artery disease; WBC: white blood cell count; ALT: alanine aminotransferase; PT: prothrombin time.
Age (years), N (%)58.3 (+9.8)59.8 (+12.5)0.640
Gender, N (%)
  Female40 (38.46%)29 (36.71%)
  Male64 (61.54%)50 (63.29%)
Race, N (%)0.818
  African American25 (24.04%)17 (21.52%)
  Hispanic60 (57.69%)43 (54.43%)
  Others17 (16.35%)17 (21.52%)
  White Caucasian2 (1.92%)2 (2.53%)
Co-morbid conditions, N (%)
  Hepatitis C66 (63.46%)50 (63.29%)0.981
  Hepatitis B1 (0.96%)5 (6.33%)0.040
  Hypertension64 (61.54%)51 (64.56%)0.676
  CKD12 (11.54%)14 (17.72%)0.235
  Diabetes mellitus40 (38.46%)27 (34.18%)0.551
  COPD6 (5.77%)5 (6.33%)0.875
  CHF9 (8.65%)4 (5.06%)0.349
  CAD9 (8.65%)5 (6.33%)0.558
  Atrial fibrillation7 (6.73%)2 (2.53%)0.193
  Psychiatric condition25 (24.04%)15 (18.99%)0.413
  HIV13 (12.50%)13 (16.46%)0.477
  Malignancy8 (7.69%)8 (10.13%)0.564
Laboratory parameters
  Hemoglobin (g/dL)10.76 (+2.06)10.60 (+1.83)0.582
  WBC (103/µL)6.63 (+3.82)5.70 (+3.34)0.082
  Neutrophil (%)62.55 (+14.22)61.20 (+13.9)0.519
  Platelet count (103/µL)123.68 (+101.46)89.34 (+45.14)0.003
  Sodium (mEq/L)136.65 (+4.36)136.24 (+4.71)0.607
  Potassium (mEq/L)4.12 (+0.67)4.02 (+0.54)0.263
  Creatinine (mg/dL)1.38 (+1.67)1.31 (+1.73)0.760
  ALT (Unit/L)109.54 (+388.32)55.49 (+63.19)0.166
  Albumin (mg/dL)2.83 (+0.78)2.72 (+0.71)0.099
  Total bilirubin (mg/dL)2.82 (+4.45)3.36 (+4.28)0.411
  PT (s)16.21 (+10.66)16 (+4.23)0.859

 

Table 2. Liver Cirrhosis Scoring and Alcohol Use in Relation to Readmission
 
Patients with no readmission (n = 104)Patients with readmission (n = 79)P-value
MELD: model for end-stage liver disease; Na: sodium.
MELD score15 ± 816 ± 60.250
MELD-Na score17 ± 719 ± 60.180
Child-Pugh class (CPT)0.013
  CPT class A, N (%)6 (13.33%)0 (0.00%)
  CPT class B, N (%)23 (51.11%)29 (50.88%)
  CPT class C, N (%)16 (35.56%)28 (49.12%)
Alcohol use within 1 month of admission, N (%)34 (32.69%)44 (55%)0.002
Alcohol use between 1 and 6 months prior to admission, N (%)32 (30.7%)33 (41%)0.123

 

Table 3. Reason for Admission, Discharge Disposition and Number of Medications at the Time of Discharge
 
Patients with no readmission (n = 104)Patients with readmission (n = 79)P-value
Reason for index admission0.693
  Ascites, N (%)44 (42.31%)36 (45.57%)
  Hepatic encephalopathy, N (%)40 (38.46%)28 (35.44)
  Variceal bleeding, N (%)11 (10.58%)11(13.92)
  Hepatocellular carcinoma, N (%)9 (8.65%)4 (5.06%)
Medical insurance0.629
  Medicare, N (%)17 (16.3%)13 (16.5%)
  Medicaid, N (%)38 (36.5%)34 (43%)
  Commercial insurance, N (%)49 (47.1 %)32 (40.5%)
Discharge disposition
   Discharge to home with services, N (%)28 (26.92%)24 (30.38%)0.680
 Discharge to home with no services, N (%)1 (0.96%)3 (3.80%)0.194
  Discharge to nursing home, N (%)20 (19.23%)25 (31.65%)0.050
  Discharge on weekend, N (%)35 (33.65%)24 (30.38%)0.630
Number of medications at the time of discharge5.2 (+3.5)7.3 (+3.9)0.005

 

Table 4. Sub-Analysis of Reason for Hospitalization for Patients in Readmission Group
 
Reason for hospitalizationIndex hospitalization for patients with readmissionSubsequent hospitalization for patients with readmissionP-value
Ascites, N (%)36 (45.5%)94 (44.97%)0.337
Hepatocellular carcinoma, N (%)4 (5.06%)9 (4.3%)
Hepatic encephalopathy, N (%)28 (35.44%)90 (43.06%)
Variceal bleeding, N (%)11 (13.92%)16 (7.65%)

 

Table 5. Post-Hospital Discharge Follow-Up and the Post-Discharge 90-Day Mortality
 
Patients with no readmission (n = 104)Patient with readmission (n = 79)P-value
7 days clinic follow-up, N (%)13 (12.50%)11 (13.92%)0.777
8 - 14 days clinic follow-up, N (%)11 (10.58%)8 (10.13%)0.921
15 - 30 day clinic follow-up, N (%)18 (17.31%)16 (20.25%)0.612
Primary care follow-up, N (%)23 (22.12%)17 (21.52%)0.923
Gastroenterology follow-up, N (%)12 (11.54%)13 (16.46%)0.337
90-day mortality, N (%)13 (12.50%)11 (13.92%)0.777

 

Table 6. Number of Unique Patients Contributing Towards Cumulative Hospital Visits
 
Study groupUnique patientsNumber of hospitalizations during the study periodCumulative number of hospital visits
aPatients at the highest risk for readmission who had four or more hospital visits during the study period.
No readmission1041104
Readmission38276
12336
11a444
7a535
4a624
2a714
3a824
1a1616
1a1919
Total number of patients with readmission79212
Total number of patients at highest risk for readmission29 (31%)176 (61%)

 

Table 7. Predictors of 30-Day Readmission in Patients With Cirrhosis Identified by Multivariate Analysis
 
VariablesP-value
Alcohol use within 1 month of admission0.016
Discharge to a nursing home0.531
Number of medications at the time of discharge0.039
Platelet count0.049