Journal Article

Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

Slaven, James, Chalasani, Naga, Akinyeye, Samuel, Mukthinuthalapati, V. V. Pavan Kedar, Balakrishnan, Maya, Long, Michelle T., Attar, Bashar M., Ghabril, Marwan, Orman, Eric S., Fricker, Zachary P., Nephew, Lauren, Vilar-Gomez, Eduardo, Syed, Moinuddin

2019

Overview

Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safety-net hospitals and the impact of race/ethnicity. A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%) patients. Patients were hospitalized mainly for ascites (35%), hepatic encephalopathy (20%) and gastrointestinal bleeding (GIB) (17%). Fifty-four (7%) patients died during hospitalization and 145 (21%) survivors were readmitted within 30 days. Mortality rates ranged from 4 to 15% by center (p = .007) and from 3 to 10% by race/ethnicity (p = .03), but 30-day readmission rates were similar. Mortality was associated with Model for End-stage Liver Disease (MELD), acute-on-chronic liver failure, hepatocellular carcinoma, sodium and white blood cell count. Thirty-day readmission was associated with MELD and Charlson Comorbidity Index >4, with lower risk for GIB. We did not observe geographic or racial/ethnic differences in hospital outcomes in the risk-adjusted analysis. Hospital mortality and 30-day readmission in patients with cirrhosis at safety-net hospitals are associated with disease severity and comorbidities, with lower readmissions in patients admitted for GIB. Despite geographic and racial/ethnic differences in hospital mortality, these factors were not independently associated with mortality.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Alcoholic beverages / Analysis / Ascites / Authorship / Baby boomers / Biology and Life Sciences / Bleeding / Carcinoma / Care and treatment / Cirrhosis / Comorbidity / Demographics / Economic aspects / Encephalopathy / Ethnic factors / Ethnic Groups - statistics & numerical data / Ethnicity / Female / Gastroenterology / Gastrointestinal hemorrhage / Health care access / Health care costs / Health insurance / Hepatic encephalopathy / Hepatitis / Hepatocellular carcinoma / Hepatology / Hospital patients / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Hospitals - statistics & numerical data / Humans / Leukocytes / Liver / Liver cancer / Liver cirrhosis / Liver Cirrhosis - pathology / Liver diseases / Liver encephalopathy / Liver failure / Liver transplants / Male / Medical prognosis / Medical research / Medical schools / Medicine / Medicine and Health Sciences / Middle Aged / Minority & ethnic groups / Mortality / Patient care / Patient Readmission - statistics & numerical data / Patient safety / Patients / Pediatrics / People and Places / Race / Retrospective Studies / Risk analysis / Safety / Safety-net Providers - statistics & numerical data / Sodium / Urban population / Urban populations / Viral hepatitis / White blood cell count