Liver international : official journal of the International Association for the Study of the Liver · 2026
Comparison of Factors Associated With 30-Day and 90-Day Readmission Among a Global Cohort of Patients Hospitalised With Cirrhosis.
СтатьяСравнительное исследованиеМногоцентровое исследованиеПоддержка правительства СШАНазвание и аннотация: Перевод в очереди
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Idilman Ramazan, Haktaniyan Busra, Choudhury Ashok, Wong Florence, Kamath Patrick S, Xie Qing, Topazian Mark, Hayes Peter C, Alvares-da-Silva Mario Reis, Torre Aldo, George Jacob, Seto Wai-Kay, Bush Brian, Silvey Scott, Thacker Leroy R, Bajaj Jasmohan S, CLEARED Investigators
Аннотация
BACKGROUND AND AIMS: It remains unclear whether different factors influence 30- and 90-day readmission rates. We identified predictors of 90-day mortality in a global cohort of hospitalised patients with cirrhosis.
METHODS: Variables associated with 30- and 90-day post-discharge readmission, liver transplantation (LT), and mortality were compared in prospectively enrolled, non-electively hospitalised adult patients with cirrhosis.
RESULTS: We enrolled 4208 patients from 125 centres across 37 countries. Alcohol-related liver disease was the most common aetiology of cirrhosis (40%), followed by hepatitis B virus infection (21%); 47% were readmitted, 8% received liver transplantation (LT), and 23% died within 90 days post-discharge. In multivariable analysis, country income was significantly associated with both 30- and 90-day readmission rates, the receipt of LT, and mortality within 30 and 90 days post-discharge (all p-values < 0.001). Independent predictors of higher rates of 30- and 90-day readmissions, respectively, were disease severity (p < 0.001, p = 0.003), prior ascites (p = 0.025, p = 0.016), prior hospitalisation (p < 0.001), hyponatremia (p < 0.001, p = 0.008), and in-hospital vasopressor use (p = 0.002, p = 0.011). Prior variceal bleeding independently predicted higher 90-day readmission rates, whereas age, disease severity, mechanical ventilation, and in-hospital vasopressor use (all, p < 0.001) increased odds of 30- and 90-day post-discharge death. Additionally, admission (p = 0.011) and nosocomial (p = 0.022) infections increased the odds of 90-day post-discharge death.
CONCLUSION: In a global cohort of hospitalised patients with cirrhosis, patients in high-income countries exhibited the highest rates of 30- and 90-day readmission, alongside lower mortality rates and a higher incidence of LT. Variables that predict 30-day readmission also predicted 90-day readmission. Understanding these disparities is essential for achieving health equity.
METHODS: Variables associated with 30- and 90-day post-discharge readmission, liver transplantation (LT), and mortality were compared in prospectively enrolled, non-electively hospitalised adult patients with cirrhosis.
RESULTS: We enrolled 4208 patients from 125 centres across 37 countries. Alcohol-related liver disease was the most common aetiology of cirrhosis (40%), followed by hepatitis B virus infection (21%); 47% were readmitted, 8% received liver transplantation (LT), and 23% died within 90 days post-discharge. In multivariable analysis, country income was significantly associated with both 30- and 90-day readmission rates, the receipt of LT, and mortality within 30 and 90 days post-discharge (all p-values < 0.001). Independent predictors of higher rates of 30- and 90-day readmissions, respectively, were disease severity (p < 0.001, p = 0.003), prior ascites (p = 0.025, p = 0.016), prior hospitalisation (p < 0.001), hyponatremia (p < 0.001, p = 0.008), and in-hospital vasopressor use (p = 0.002, p = 0.011). Prior variceal bleeding independently predicted higher 90-day readmission rates, whereas age, disease severity, mechanical ventilation, and in-hospital vasopressor use (all, p < 0.001) increased odds of 30- and 90-day post-discharge death. Additionally, admission (p = 0.011) and nosocomial (p = 0.022) infections increased the odds of 90-day post-discharge death.
CONCLUSION: In a global cohort of hospitalised patients with cirrhosis, patients in high-income countries exhibited the highest rates of 30- and 90-day readmission, alongside lower mortality rates and a higher incidence of LT. Variables that predict 30-day readmission also predicted 90-day readmission. Understanding these disparities is essential for achieving health equity.