Gastroenterol Res

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

**Table 1.** Baseline Demographic, Co-Morbid Conditions and Laboratory Parameters Stratified Between the Two Groups
Variables	Patients 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 (%)
Female	40 (38.46%)	29 (36.71%)
Male	64 (61.54%)	50 (63.29%)
Race, N (%)			0.818
African American	25 (24.04%)	17 (21.52%)
Hispanic	60 (57.69%)	43 (54.43%)
Others	17 (16.35%)	17 (21.52%)
White Caucasian	2 (1.92%)	2 (2.53%)
Co-morbid conditions, N (%)
Hepatitis C	66 (63.46%)	50 (63.29%)	0.981
Hepatitis B	1 (0.96%)	5 (6.33%)	0.040
Hypertension	64 (61.54%)	51 (64.56%)	0.676
CKD	12 (11.54%)	14 (17.72%)	0.235
Diabetes mellitus	40 (38.46%)	27 (34.18%)	0.551
COPD	6 (5.77%)	5 (6.33%)	0.875
CHF	9 (8.65%)	4 (5.06%)	0.349
CAD	9 (8.65%)	5 (6.33%)	0.558
Atrial fibrillation	7 (6.73%)	2 (2.53%)	0.193
Psychiatric condition	25 (24.04%)	15 (18.99%)	0.413
HIV	13 (12.50%)	13 (16.46%)	0.477
Malignancy	8 (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 1. Baseline Demographic, Co-Morbid Conditions and Laboratory Parameters Stratified Between the Two Groups

Variables

Patients 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 (%)

Female

40 (38.46%)

29 (36.71%)

Male

64 (61.54%)

50 (63.29%)

Race, N (%)

0.818

African American

25 (24.04%)

17 (21.52%)

Hispanic

60 (57.69%)

43 (54.43%)

Others

17 (16.35%)

17 (21.52%)

White Caucasian

2 (1.92%)

2 (2.53%)

Co-morbid conditions, N (%)

Hepatitis C

66 (63.46%)

50 (63.29%)

0.981

Hepatitis B

1 (0.96%)

5 (6.33%)

0.040

Hypertension

64 (61.54%)

51 (64.56%)

0.676

CKD

12 (11.54%)

14 (17.72%)

0.235

Diabetes mellitus

40 (38.46%)

27 (34.18%)

0.551

COPD

6 (5.77%)

5 (6.33%)

0.875

CHF

9 (8.65%)

4 (5.06%)

0.349

CAD

9 (8.65%)

5 (6.33%)

0.558

Atrial fibrillation

7 (6.73%)

2 (2.53%)

0.193

Psychiatric condition

25 (24.04%)

15 (18.99%)

0.413

HIV

13 (12.50%)

13 (16.46%)

0.477

Malignancy

8 (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 score	15 ± 8	16 ± 6	0.250
MELD-Na score	17 ± 7	19 ± 6	0.180
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 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 score

15 ± 8

16 ± 6

0.250

MELD-Na score

17 ± 7

19 ± 6

0.180

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 admission			0.693
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 insurance			0.629
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 discharge	5.2 (+3.5)	7.3 (+3.9)	0.005

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 admission

0.693

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 insurance

0.629

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 discharge

5.2 (+3.5)

7.3 (+3.9)

0.005

**Table 4.** Sub-Analysis of Reason for Hospitalization for Patients in Readmission Group
Reason for hospitalization	Index hospitalization for patients with readmission	Subsequent hospitalization for patients with readmission	P-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 4. Sub-Analysis of Reason for Hospitalization for Patients in Readmission Group

Reason for hospitalization

Index hospitalization for patients with readmission

Subsequent hospitalization for patients with readmission

P-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 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 group	Unique patients	Number of hospitalizations during the study period	Cumulative number of hospital visits
^aPatients at the highest risk for readmission who had four or more hospital visits during the study period.
No readmission	104	1	104
Readmission	38	2	76
	12	3	36
	11^a	4	44
	7^a	5	35
	4^a	6	24
	2^a	7	14
	3^a	8	24
	1^a	16	16
	1^a	19	19
Total number of patients with readmission	79		212
Total number of patients at highest risk for readmission	29 (31%)		176 (61%)

Table 6. Number of Unique Patients Contributing Towards Cumulative Hospital Visits

Study group

Unique patients

Number of hospitalizations during the study period

Cumulative number of hospital visits

^aPatients at the highest risk for readmission who had four or more hospital visits during the study period.

No readmission

104

Readmission

11^a

7^a

4^a

2^a

3^a

1^a

Total number of patients with readmission

212

Total number of patients at highest risk for readmission

29 (31%)

176 (61%)

**Table 7.** Predictors of 30-Day Readmission in Patients With Cirrhosis Identified by Multivariate Analysis
Variables	P-value
Alcohol use within 1 month of admission	0.016
Discharge to a nursing home	0.531
Number of medications at the time of discharge	0.039
Platelet count	0.049

Table 7. Predictors of 30-Day Readmission in Patients With Cirrhosis Identified by Multivariate Analysis

Variables

P-value

Alcohol use within 1 month of admission

0.016

Discharge to a nursing home

0.531

Number of medications at the time of discharge

0.039

Platelet count

0.049