In the Journals

In-hospital cirrhosis mortality rates down, post-discharge mortality up

Researchers observed a substantial reduction in in-hospital mortality among patients with cirrhosis during the last 10 years; however, it appears the mortality risk has shifted to the 30-day post-discharge period, possibly due to shorter hospital stays.

“Information about the absolute risk of mortality in the posthospitalization period is important for several reasons. It can help inform patients and their health care professionals about the actual risk of dying after leaving the hospital; it can also help inform the timing of heightened surveillance after hospital discharge,” Fasiha Kanwal, MD, MSHS, from the Michael E. DeBakey Veterans Affairs Medical Center, Houston, and colleagues wrote. “These data can also guide hospitals to more efficiently align their interventions designed to reduce adverse outcomes in patients with cirrhosis.”

Kanwal and colleagues examined the in-hospital (30 days) and post-discharge (1 year) mortality rates of 109,358 patients from Veterans Affairs hospitals from 2004 to 2013. Mean patient age increased from 60.5 years in 2004 to 63.4 years in 2013.

In 2004, 11,123 patients were admitted for cirrhosis and had a mean stay of 13.6 days. Of those, 11.5% died in-hospital, 9.4% died during 30-days post-discharge and 34.5% died during 1-year post-discharge.

In 2013, 12,176 patients were hospitalized for a mean of 9.3 days. During that year, 7.6% died in-hospital, 10.1% died 30-days post-discharge and 33.3% died during 1-year post-discharge.

Researchers observed a 3.8% rate decrease in in-hospital mortality from 2004 to 2013, representing a 33% relative reduction (P < .0001). The mortality rate 1-year post-discharge was 1.3%, yielding a smaller relative reduction of 3.7% (P = .012).

Compared with 2004, the rate of in-hospital morality was 30% lower in 2013 (OR = 0.7; 95% CI, 0.64-0.78). The risk for death 1-year post-discharge also decreased from 2004 to 2013 (OR = 0.87; 95% CI, 0.82-0.93). This was due to improved survival after the initial 30-days post-discharge in 2013 (OR = 0.83; 95% CI, 0.77-0.89). The risk-adjusted mortality within 30-days post-discharge otherwise increased by 10% from 2004 to 2013 (OR = 1.1; 95% CI, 0.99-1.21).

Factors the data associated with greater risk for in-hospital and post-discharge mortality included older age, alcohol- and other non-hepatitis-related cirrhosis, history of smoking, more severe medical comorbidities and previous non-cirrhosis related hospitalizations.

“These patient groups can serve as key targets for transitional care interventions including early outpatient follow-up and home-visiting programs, as well as interventions for alcohol abstinence,” the researchers wrote.

Additionally, liver disease severity affected mortality rates, especially during the 30-day post-discharge period.

“Currently, there are no programs that support transitional and long-term care specifically for patients with cirrhosis,” the researchers advised. “Such quality improvement programs might counterbalance and/or complement the in-patient programs to further improve the observed modest decreases in overall mortality in hospitalized cirrhosis patients.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

Researchers observed a substantial reduction in in-hospital mortality among patients with cirrhosis during the last 10 years; however, it appears the mortality risk has shifted to the 30-day post-discharge period, possibly due to shorter hospital stays.

“Information about the absolute risk of mortality in the posthospitalization period is important for several reasons. It can help inform patients and their health care professionals about the actual risk of dying after leaving the hospital; it can also help inform the timing of heightened surveillance after hospital discharge,” Fasiha Kanwal, MD, MSHS, from the Michael E. DeBakey Veterans Affairs Medical Center, Houston, and colleagues wrote. “These data can also guide hospitals to more efficiently align their interventions designed to reduce adverse outcomes in patients with cirrhosis.”

Kanwal and colleagues examined the in-hospital (30 days) and post-discharge (1 year) mortality rates of 109,358 patients from Veterans Affairs hospitals from 2004 to 2013. Mean patient age increased from 60.5 years in 2004 to 63.4 years in 2013.

In 2004, 11,123 patients were admitted for cirrhosis and had a mean stay of 13.6 days. Of those, 11.5% died in-hospital, 9.4% died during 30-days post-discharge and 34.5% died during 1-year post-discharge.

In 2013, 12,176 patients were hospitalized for a mean of 9.3 days. During that year, 7.6% died in-hospital, 10.1% died 30-days post-discharge and 33.3% died during 1-year post-discharge.

Researchers observed a 3.8% rate decrease in in-hospital mortality from 2004 to 2013, representing a 33% relative reduction (P < .0001). The mortality rate 1-year post-discharge was 1.3%, yielding a smaller relative reduction of 3.7% (P = .012).

Compared with 2004, the rate of in-hospital morality was 30% lower in 2013 (OR = 0.7; 95% CI, 0.64-0.78). The risk for death 1-year post-discharge also decreased from 2004 to 2013 (OR = 0.87; 95% CI, 0.82-0.93). This was due to improved survival after the initial 30-days post-discharge in 2013 (OR = 0.83; 95% CI, 0.77-0.89). The risk-adjusted mortality within 30-days post-discharge otherwise increased by 10% from 2004 to 2013 (OR = 1.1; 95% CI, 0.99-1.21).

Factors the data associated with greater risk for in-hospital and post-discharge mortality included older age, alcohol- and other non-hepatitis-related cirrhosis, history of smoking, more severe medical comorbidities and previous non-cirrhosis related hospitalizations.

“These patient groups can serve as key targets for transitional care interventions including early outpatient follow-up and home-visiting programs, as well as interventions for alcohol abstinence,” the researchers wrote.

Additionally, liver disease severity affected mortality rates, especially during the 30-day post-discharge period.

“Currently, there are no programs that support transitional and long-term care specifically for patients with cirrhosis,” the researchers advised. “Such quality improvement programs might counterbalance and/or complement the in-patient programs to further improve the observed modest decreases in overall mortality in hospitalized cirrhosis patients.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.