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Volume 13 Issue 1 (January) 2024

Original Articles

Factors Predicting Early Re-Admission and Mortality in Cirrhotic Patients - Experience of a Tertiary Care Centre
Dr. Awanish Kumar, Dr. Anand Shankar, Dr. Manish Kumar

Background& Objectives:Over the years, liver cirrhosis has become an increasingly common cause of death worldwide. Early hospital readmission rate after discharge is now considered as a surrogate marker of quality of any healthcare delivery system. Each such readmission puts financial burden on patients and their families as well as employs significant amount of healthcare resources. Identification of factors influencing these readmissions and thereby their prevention is of utmost importance for a sustainable healthcare system. In the present study, we intended to study hospital readmission, mortality rates and predictive factors for hospital readmission and mortality in adults with cirrhosis in Indian scenario.Methods:This prospective observational study was conducted in medicine department of NSMCH, Bihta, Bihar, India over 2 years from December 2021 to November 2023 including adults admitted with liver cirrhosis at our institute for the first time. Data was collected regarding demography, aetiology, complications, laboratory parameters, MELD score and CPT score. All participants were followed up for 3 months. Occurrence of readmission and/or death was recorded and studied.Result:Over the study period, we included 143 hospitalized cirrhotic patients in our study. Mean age was 48.4 ± 11.9 years. 119 (83.2%) were males and only 24 (16.8%) were females. The commonest aetiology of cirrhosis was alcoholism (56.6%), followed by hepatitis B (16.1%), non-alcoholic steatohepatitis (10.5%) and cryptogenic cirrhosis (9.1%). Decompensation events responsible for index hospitalization were ascites (48.3%), GI bleed due to portal hypertension (19.6%), renal failure (10.5%), spontaneous bacterial peritonitis (9.1%) and hepatic encephalopathy (7.7%). Mean duration of hospitalization was 8.42 ± 4.36 days and average MELD score was 13.71 ± 4.7. Overall, 56 (39.2%) patients needed to be re-admitted before 3 months for 1 or more times. Patients who needed readmission had a worse cirrhosis as indicated by a significantly higher MELD score and CTP score. Also, ALT level and INR were significantly higher in patients requiring re-admission. There were 20 (14%) deaths in the study population within 3 months of discharge. Age more than 60 years and higher MELD scores were associated with an increased risk of 90-day mortality.Conclusion:Our study underscores a high rate of readmission as well as short term mortality in patients with advanced liver disease. We suggest that patient–physician discussions should be detailed out so as to direct either very aggressive treatment or palliative care.

 
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