Vnitr Lek 2023, 69(8):500-505 | DOI: 10.36290/vnl.2023.100

Rate of repeated hospitalization of patients with cirrhosis and its risk factors

Petra Vrbová, Tomáš Koller

V. interná klinika LF UK a UN Bratislava

Background: Patients with cirrhosis make up a non-negligible part of hospitalized patients and are often hospitalized repeatedly. The aim of our work was to find out what happens to patients after being discharged from the hospital to outpatient care, how often they are re-hospitalized, what their prognosis is, and what are the risk factors for these events.

Methods: Data on consecutive patients hospitalized with complications of cirrhosis at the V. internal clinic were recorded in the database. We monitored demographic, social and basic laboratory parameters along with prognostic indices. We recorded the rate of the first event after discharge within 30 and 90 days, which could be hospitalization or death. Subsequently, we evaluated mortality within 30 and 90 days according to the first event, and finally also the risk factors of death and repeated hospitalization after discharge.

Results: During the monitored period of 2 years, we recorded data on 110 hospitalized patients. For all patients, a minimum of 6 months passed from registration in the database to the evaluation of events after discharge or data censoring. From the whole set, 54 patients (49.1%) were repeatedly hospitalized, the number of repeated hospitalizations was from 1 to 8. Furthermore, 27 patients (24.5%) died without repeated hospitalization and 29 patients (26.4%) survived the observed period without repeated hospitalization. We recorded repeated hospitalization within 30 and 90 days in 12 (11%) and 32 (29.1%) patients. Among 54 repeatedly hospitalized patients, we recorded 30- and 90-day mortality in 2 (3.7%) and 9 (16.7%). Among 27 patients who died without re-hospitalization, we recorded 30- and 90-day mortality in 16 (59.3%) and 21 (77.8%). In multivariate analysis for competing events during follow-up (rehospitalization vs. death), we found that acute alcoholic hepatitis (HR=0.0), INR (HR=0.42), number of people living in the patient's household (HR=1.36), platelets (HR=0.99), and cholelithiasis (HR=2.51) were independent risk factors for rehospitalization. Independent risk factors for death were MELD-Na score (HR=1.09), CLIF-ACLF score (HR=1.99), and homeless status (HR=2.99).

Conclusion: Rehospitalization within 1 and 3 months of discharge was common, but nearly a quarter of patients died without rehospitalization. Risk factors for repeated hospitalization were INR, number of people living in the patient's household, platelets and cholelithiasis. Patients with acute alcoholic hepatitis were repeatedly hospitalized only rarely.

Keywords: cirrhosis, repeated hospitalization, mortality, risk factors.

Accepted: November 27, 2023; Published: December 18, 2023  Show citation