title: Advanced disease, diuretic use, and marital status predict hospital admissions in an ambulatory cirrhosis cohort.
abstract: OBJECTIVE
  Hospital admissions in cirrhotic patients are a source of significant health care expenditure. Most studies to date have focused on readmissions in patients with decompensated cirrhosis. We sought to describe predictors of hospital admissions in an ambulatory cirrhosis cohort consisting of both compensated and decompensated patients to identify patients who could benefit from intensified outpatient chronic disease management.
  
  
  METHODS
  We performed a retrospective cohort study of 395 cirrhotic patients followed at an academic medical center liver clinic. Inclusion criteria were documented cirrhosis and longitudinal care at our center during 2006-2008. Patients were followed until December 2011, death, or liver transplantation. The primary outcomes were non-elective cirrhosis-related hospital admissions within 1 year and time to admission. The secondary outcome was 2-year cirrhosis-related mortality. The study was approved by the Partners Human Research Committee (protocol 2012P001912).
  
  
  RESULTS
  Seventy-eight patients (19.7 %) had at least one cirrhosis-related hospital admission within 1 year. The following were significant predictors in the multivariable model: model for end-stage liver disease score ≥15 [OR 2.22, 95 % CI (1.21-4.07), p = 0.01], diagnosis of hepatocellular carcinoma [3.64 (1.42-9.35), 0.007], diuretic use [2.27 (1.23-4.17), 0.008], at least one cirrhosis-related admission during the baseline year [2.17 (1.21-3.89), 0.01], and being unmarried [1.92 (1.10-3.35), 0.02].
  
  
  CONCLUSIONS
  Advanced disease, diuretic use, and marital status were associated with cirrhosis-related hospital admissions in patients followed at an academic medical center liver clinic. Our findings suggest that patients with inadequately or overzealously treated ascites, as well as those with limited social supports, could benefit from intensified outpatient management.
authors.affiliation: Harvard Medical School, Boston, MA, USA, kara_johnson@hms.harvard.edu.
authors.forename: Kara B
authors.initials: KB
authors.lastname: Johnson
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Campbell
authors.forename: Heng
authors.initials: H
authors.lastname: Chi
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: Lindsay Y
authors.initials: LY
authors.lastname: King
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.forename: Andrew
authors.initials: A
authors.lastname: Delemos
authors.forename: Abu
authors.initials: A
authors.lastname: Hurairah
authors.forename: Kathleen
authors.initials: K
authors.lastname: Corey
authors.forename: James M
authors.initials: JM
authors.lastname: Richter
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004232:Diuretics