title: The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis.
abstract: In smaller single-center studies, patients with cirrhosis are at a high readmission risk, but a multicenter perspective study is lacking. We evaluated the determinants of 3-month readmissions among inpatients with cirrhosis using the prospective 14-center North American Consortium for the Study of End-Stage Liver Disease cohort. Patients with cirrhosis hospitalized for nonelective indications provided consent and were followed for 3 months postdischarge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions and for hepatic encephalopathy (HE), renal/metabolic, and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. Of the 1353 patients enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n = 535; 316 with one, 219 with two or more), with consistent rates across sites. The leading causes were liver-related (n = 333; HE, renal/metabolic, and infections). Patients with cirrhosis and with worse Model for End-Stage Liver Disease score or diabetes, those taking prophylactic antibiotics, and those with prior HE were more likely to be readmitted. The admission model included Model for End-Stage Liver Disease and diabetes (c-statistic = 0.64, after split-validation 0.65). The discharge model included Model for End-Stage Liver Disease, proton pump inhibitor use, and lower length of stay (c-statistic = 0.65, after split-validation 0.70). Thirty percent of readmissions could not be predicted. Patients with liver-related readmissions consistently had index-stay nosocomial infections as a predictor for HE, renal/metabolic, and infection-associated readmissions (odds ratio = 1.9-3.0).
  
  
  
  Three-month readmissions occurred in about half of discharged patients with cirrhosis, which were associated with cirrhosis severity, diabetes, and nosocomial infections; close monitoring of patients with advanced cirrhosis and prevention of nosocomial infections could reduce this burden. (Hepatology 2016;64:200-208).
authors.affiliation: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.affiliation: University of Alberta, Edmonton, AB, Canada.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Yale University, New Haven, CT.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.affiliation: University of Rochester, Rochester, NY.
authors.forename: Benedict
authors.initials: B
authors.lastname: Maliakkal
authors.affiliation: University of Colorado, Denver, CO.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.affiliation: Mercy Medical Center, Baltimore, MD.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
authors.affiliation: University of Texas, Houston, TX.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Ram M
authors.initials: RM
authors.lastname: Subramanian
authors.affiliation: Mayo Clinic, Scottsdale, AZ.
authors.forename: Hugo
authors.initials: H
authors.lastname: Vargas
authors.affiliation: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
authors.forename: Leroy R
authors.initials: LR
authors.lastname: Thacker
authors.affiliation: Baylor University Medical Center, Dallas, TX.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis; D008297:Male; D008875:Middle Aged; D009656:North America; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies