Clinical and patient-reported predictors of days alive and out of hospital in decompensated cirrhosis.

BACKGROUND

Days alive and out of hospital (DAOH) is a patient-centered outcome, but has not been studied in decompensated cirrhosis (DCC). We aimed to quantify DAOH and to identify clinical and patient-reported factors associated with DAOH.

METHODS

Using an ongoing prospective cohort study of adults hospitalized with DCC, DAOH was calculated by subtracting days hospitalized, transplanted, or deceased from 90 days post-discharge from index hospitalization. Univariable and multivariable negative binomial hurdle models were used to identify clinical and patient-reported variables associated with DAOH, where DAOH was treated both as a categorical (any readmission, transplant, death vs. all 90-DAOH) and continuous (proportion of event days) outcome.

RESULTS

Among 363 adults (median age 54 y; MELD 3.0 score 23), 40% experienced all 90-DAOH while 90-day readmission, death, and transplant occurred in 49%, 21%, 11%, respectively. Mean DAOH was 68.3 (SD: 29.0). In multivariable models, transplant evaluation status (listed vs. not listed/evaluated: OR 7.55, p=0.004) was associated with experiencing an event within 90 days. In comparison, when considering the number of event days, higher PROMIS Ability to Participate in Social Roles and Activities scores were independently associated with a lower proportion of event days (rate ratio, RR 0.91 per 3-point increase, p=0.030) in addition to MELD 3.0 >25 (vs. <15, RR 2.75, p<0.001).

CONCLUSIONS

DAOH is a holistic, patient-centered outcome for decompensated cirrhosis that integrates readmission, transplantation, and mortality into a single measure of post-discharge burden. By using DAOH and moving beyond readmissions, we show that lower MELD 3.0 and higher patient-reported social well-being were independently associated with more days at home after hospitalization.