Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?

Fagan, Kevin J.; Zhao, Ensheng; Horsfall, Leigh; Ruffin, Brittany J; Kruger, Mark; McPhail, Steven; O’Rourke, Peter; Ballard, Emma; Irvine, Katharine M.; Powell, Elizabeth E.

doi:10.1111/imj.12491

Cited by 53 publications

(50 citation statements)

References 33 publications

(54 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Features of decompensated cirrhosis, including variceal bleeding, ascites and hepatic encephalopathy (HE), have a detrimental impact on patient quality of life and survival . Patients with decompensated cirrhosis require extensive ongoing healthcare . Recent guidelines recommend close monitoring, prophylaxis and management of patients with decompensated cirrhosis .…”

Section: Introductionmentioning

confidence: 99%

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Shaheen

Nguyen

Congly

et al. 2019

Liver International

View full text Add to dashboard Cite

Background The burden of cirrhosis on the healthcare system is substantial and growing. Our objectives were to estimate the readmission rates and hospitalization costs as well as to identify risk factors for 90‐day readmission in patients with cirrhosis. Methods We conducted a weighted analysis of the 2014 Nationwide Readmission Database to identify adult patients with cirrhosis‐related complications in the United States and assessed readmission rates at 30, 60 and 90 days post‐index hospitalization. Predictors of 90‐day readmissions were identified using weighted regression models adjusting for patient and hospital characteristics; the national estimate of hospitalization costs was also calculated. Results Of the 58 954 patients admitted with cirrhosis‐related complications in 2014, 14 910 (25%) were readmitted within 90 days because of cirrhosis‐related complications. The main causes of readmission were ascites (56%), hepatic encephalopathy (47%) and bleeding oesophageal varices (9%). Independent predictors of 90‐day readmissions were male sex (adjusted OR [aOR]: 1.08, 95% CI, 1.04‐1.13), age <60 (aOR: 1.27, 95% CI, 1.22‐1.32), privately insured (aOR: 0.74, 95% CI, 0.70‐0.77), having ≥3 comorbid conditions (aOR: 1.27, 95% CI, 1.14‐1.42) and being discharged against medical advice (aOR: 1.41, 95% CI, 1.25‐1.59). The weighted cumulative national cost estimate of the index admission was $1.8 billion, compared to $0.5 billion for readmission. Conclusions A quarter of patients admitted with cirrhosis‐related complications were readmitted within 90 days, representing a significant economic burden related to readmission of this population. Interventions and resource allocations to reduce readmission rates among cirrhotic patients is critical.

show abstract

Section: Introductionmentioning

confidence: 99%

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Shaheen

Nguyen

Congly

et al. 2019

Liver International

View full text Add to dashboard Cite

show abstract

“…Cirrhosis typically has an asymptomatic phase (compensated cirrhosis) followed by a rapidly progressive phase (decompensated cirrhosis) signaled by the development of complications of liver dysfunction (ascites, variceal bleeding, encephalopathy, jaundice). Patients with decompensated cirrhosis have high morbidity and mortality and consequently place a heavy burden on health resources (1). Bacterial infections, which occur in one-third of admitted patients with cirrhosis, account for a 4-fold increase in mortality (2), and the high mortality rate after infection (28.6% at 1 month, 63% at 1 year) has not changed substantially over recent decades (2,3).…”

Section: Introductionmentioning

confidence: 99%

CRIg-expressing peritoneal macrophages are associated with disease severity in patients with cirrhosis and ascites

Irvine¹,

Banh²,

Gadd³

et al. 2016

JCI Insight

View full text Add to dashboard Cite

“…On average, this patient group has approximately three hospital admissions each year [1, 5], reflecting the high burden of illness and use of health care resources. The number of medications prescribed on hospital discharge has been found to predict rehospitalization rate and time to first hospital readmission, independently of serum biomarkers that also predict poor outcomes [2].…”

Section: Introductionmentioning

confidence: 99%

Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

Hayward

Martin

Cottrell

et al. 2017

Trials

View full text Add to dashboard Cite

BackgroundPeople with decompensated cirrhosis require complex medical care and are often prescribed an intricate and frequently changing medication and lifestyle regimen. However, many patients mismanage their medications or have poor comprehension of their disease and self-management tasks. This can lead to harm, hospitalization, and death.Methods/designA patient-oriented education and medication management intervention has been developed for implementation at a tertiary hospital hepatology outpatient center in Queensland, Australia. Consenting patients with decompensated cirrhosis will be randomly allocated to education intervention or usual care treatment arms when they attend routine follow-up appointments. In the usual care arm, participants will be reviewed by their hepatologist according to the current model of care in the hepatology clinic. In the intervention arm, participants will be reviewed by a clinical pharmacist to receive the education and medication management intervention at baseline in addition to review by their hepatologist. Intervention participants will also receive three further educational contacts from the clinical pharmacist within the following 6-month period, in addition to routine hepatologist review that is scheduled within this time frame. All participants will be surveyed at baseline and follow-up (approximately 6 months post-enrollment). Validated questionnaire tools will be used to determine participant adherence, medication beliefs, illness perceptions, and quality of life. Patients’ knowledge of dietary and lifestyle modifications, their current medications, and other clinical data will be obtained from the survey, patient interview, and medical records. Patient outcome data will be collected at 52 weeks.DiscussionThe intervention described within this protocol is ready to adapt and implement in hepatology ambulatory care centers globally. Investigation of potentially modifiable variables that may impact medication management, in addition to the effect of a clinical pharmacist-driven education and medication management intervention on modifying these variables, will provide valuable information for future management of these patients.Trial registrationAustralian and New Zealand Clinical Trial Registry identifier: ACTRN12616000780459. Registered on 15 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2075-4) contains supplementary material, which is available to authorized users.

show abstract

Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?

Cited by 53 publications

References 33 publications

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States

CRIg-expressing peritoneal macrophages are associated with disease severity in patients with cirrhosis and ascites

Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial

Contact Info

Product

Resources

About