Predictive models of mortality and hospital readmission of patients with decompensated liver cirrhosis

Gaspar, Rui; Rodrigues, Susana; Silva, Marco; Costa-Moreira, Pedro; Morais, Rui; Andrade, Patrícia; Cardoso, Hélder; Albuquerque, Andreia; Liberal, Rodrigo; Macedo, Guilherme

doi:10.1016/j.dld.2019.03.016

Cited by 28 publications

(20 citation statements)

References 28 publications

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“…This validated scoring system helped classify patients into low (< 20%), medium (20–30%), and high (> 30%) risk of readmission at 30 days [ 27 ]. Similarly, Gaspar et al developed predictive models for readmission and 180-day mortality using factors associated with readmission and mortality, respectively [ 28 ]. Such models could be used to guide directed interventions.…”

Section: Resultsmentioning

confidence: 99%

Strategies to Improve Delivery of Cirrhosis Care

Moghe

Yakovchenko

Morgan

et al. 2021

Curr Treat Options Gastro

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Purpose of review This review provides an overview of the current state of research around improving healthcare delivery for patients with cirrhosis in the outpatient, inpatient, and transitional care settings. Recent findings Recent studies have broadly employed changes to the model of care delivery, team composition, and technology to improve cirrhosis care. In the outpatient setting, approaches have included engaging caregivers, patient navigators, and nonphysicians and using virtual care, smartphone applications, and wearables. Inpatient care approaches have focused on the role of interdisciplinary teams, education interventions, and changes to the medical record system, while post-discharge interventions have included day hospitals and care coordinator interventions. This review also describes the Veterans Health Administration's novel, population-level approach to delivery of cirrhosis care, and addressed how the pandemic has impacted the delivery of cirrhosis care. Summary Comprehensive, evidence-based approaches to delivering high-quality cirrhosis care continue to evolve to meet the needs of a growing population in an ever-changing healthcare environment.

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Section: Resultsmentioning

confidence: 99%

Strategies to Improve Delivery of Cirrhosis Care

Moghe

Yakovchenko

Morgan

et al. 2021

Curr Treat Options Gastro

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“…In addition, HCs must have contact with a reference caregiver to better manage therapeutic adherence at home in order to avoid inpatient care. In fact, 78% of hospital readmissions of patients with decompensated cirrhosis were totally or partially due to ALC, and almost 45% of them were for hepatic encephalopathy [ 85 ]; thus, the management of this complication at home with the help of a caregiver is of a crucial importance [ 86 ]. Indeed, the presence of formal and well-trained caregivers periodically in contact with the patient and his/her family can improve the quality of life of both the patient and the family; this figure also enhances the activity of the health service, reducing the number of accesses to the emergency room or ordinary hospitalization [ 87 , 88 ].…”

Section: Management Of Ald/aud In the Covid-19 Disease Eramentioning

confidence: 99%

“…ALC decompensation (ascites, variceal bleeding, and hepatic encephalopathy) is the major reason for hospitalization in patients affected by ALC, together with liver transplant rejection or other clinical ALC complications (hepatorenal and hepatopulmonary syndrome, ACLF, and spontaneous bacterial peritonitis) [ 35 , 85 ]. It would be better for patients to be admitted to COVID-19 disease-free liver units.…”

Section: Management Of Ald/aud In the Covid-19 Disease Eramentioning

confidence: 99%

Alcohol-Related Liver Disease in the Covid-19 Era: Position Paper of the Italian Society on Alcohol (SIA)

et al. 2021

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Background Coronavirus Disease 2019 (COVID-19), firstly reported in China last November 2019, became a global pandemic. It has been shown that periods of isolation may induce a spike in alcohol use disorder (AUD). In addition, alcohol-related liver disease (ALD) is the most common consequence of excessive alcohol consumption worldwide. Moreover, liver impairment has also been reported as a common manifestation of COVID-19. Aims The aim of our position paper was to consider some critical issues regarding the management of ALD in patients with AUD in the era of COVID-19. Methods A panel of experts of the Italian Society of Alcohology (SIA) met via “conference calls” during the lockdown period to draft the SIA’s criteria for the management of ALD in patients with COVID-19 as follows: (a) liver injury in patients with ALD and COVID-19 infection; (b) toxicity to the liver of the drugs currently tested to treat COVID-19 and the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) reorganization of the management of compensated and decompensated ALD and liver transplantation in the COVID-19 era. Results and Conclusions The COVID-19 pandemic has rapidly carried us toward a new governance scenario of AUD and ALD which necessarily requires an in-depth review of the management of these diseases with a new safe approach (management of out-patients and in-patients following new rules of safety, telemedicine, telehealth, call meetings with clinicians, nurses, patients, and caregivers) without losing the therapeutic efficacy of multidisciplinary treatment.

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“…An estimated 27.1% of readmissions may be avoidable (5). To date, several studies have focused on assessing the predictors of readmission in decompensated cirrhosis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, hospital readmission rates of patients with cirrhosis remain high, ranging from 10 to 50%, with a pooled estimate of 26% at 30 days and 21-71% at 90 days (19).…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

Tan

Wang

et al. 2021

Front. Med.

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Background and Aims: Patients with acute decompensated (AD) cirrhosis are frequently readmitted to the hospital. An accurate predictive model for identifying high-risk patients may facilitate the development of effective interventions to reduce readmission rates.Methods: This cohort study of patients with AD cirrhosis was conducted at six tertiary hospitals in China between September 2012 and December 2016 (with 705 patients in the derivation cohort) and between January 2017 and April 2020 (with 251 patients in the temporal validation cohort). Least absolute shrinkage and selection operator Cox regression was used to identify the prognostic factors and construct a nomogram. The discriminative ability, calibration, and clinical net benefit were evaluated based on the C-index, area under the curve, calibration curve, and decision curve analysis. Kaplan–Meier curves were constructed for stratified risk groups, and log-rank tests were used to determine significant differences between the curves.Results: Among 956 patients, readmission rates were 24.58, 42.99, and 51.78%, at 30, 60, and 90 days, respectively. Bacterial infection was the main reason for index hospitalization and readmission. Independent factors in the nomogram included gastrointestinal bleeding [hazard rate (HR): 2.787; 95% confidence interval (CI): 2.221–3.499], serum sodium (HR: 0.955; 95% CI: 0.933–0.978), total bilirubin (HR: 1.004; 95% CI: 1.003–1.005), and international normalized ratio (HR: 1.398; 95% CI: 1.126–1.734). For the convenience of clinicians, we provided a web-based calculator tool (https://cqykdx1111.shinyapps.io/dynnomapp/). The nomogram exhibited good discrimination ability, both in the derivation and validation cohorts. The predicted and observed readmission probabilities were calibrated with reliable agreement. The nomogram demonstrated superior net benefits over other score models. The high-risk group (nomogram score >56.8) was significantly likely to have higher rates of readmission than the low-risk group (nomogram score ≤ 56.8; p < 0.0001).Conclusions: The nomogram is useful for assessing the probability of short-term readmission in patients with AD cirrhosis and to guide clinicians to develop individualized treatments based on risk stratification.

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Predictive models of mortality and hospital readmission of patients with decompensated liver cirrhosis

Cited by 28 publications

References 28 publications

Strategies to Improve Delivery of Cirrhosis Care

Strategies to Improve Delivery of Cirrhosis Care

Alcohol-Related Liver Disease in the Covid-19 Era: Position Paper of the Italian Society on Alcohol (SIA)

Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days

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