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Validation of Risk Score in Predicting Early Readmissions in Decompensated Cirrhotic Patients: A Model Based on the Administrative Database
Author(s) -
Mumtaz Khalid,
Issak Abdulfatah,
Porter Kyle,
Kelly Sean,
Hanje James,
Michaels Anthony J.,
Conteh Lanla F.,
ElHinnawi Ashraf,
Black Sylvester M.,
Abougergi Marwan S.
Publication year - 2019
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30274
Subject(s) - medicine , cirrhosis , hepatic encephalopathy , medicaid , decompensation , logistic regression , emergency medicine , cohort , retrospective cohort study , diagnosis code , psychological intervention , intensive care medicine , database , health care , population , environmental health , economics , economic growth , psychiatry , computer science
Early readmission in patients with decompensated liver cirrhosis leads to an enormous burden on health care use. A retrospective cohort study using the 2013 and 2014 Nationwide Readmission Database (NRD) was conducted. Patients with a diagnoses of cirrhosis and at least one feature of decompensation were included. The primary outcome was to develop a validated risk model for early readmission. Secondary outcomes were to study the 30‐day all‐cause readmission rate and the most common reasons for readmission. A multivariable logistic regression model was fit to identify predictors of readmissions. Finally, a risk model, the Mumtaz readmission risk score, was developed for prediction of 30‐day readmission based on the 2013 NRD and validated on the 2014 NRD. A total of 123,011 patients were included. The 30‐day readmission rate was 27%, with 79.6% of patients readmitted with liver‐related diagnoses. Age <65 years; Medicare or Medicaid insurance; nonalcoholic etiology of cirrhosis; ≥3 Elixhauser score; presence of hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma, paracentesis, or hemodialysis; and discharge against medical advice were independent predictors of 30‐day readmission. This validated model enabled patients with decompensated cirrhosis to be stratified into groups with low (<20%), medium, (20%‐30%), and high (>30%) risk of 30‐day readmissions. Conclusion: One third of patients with decompensated cirrhosis are readmitted within 30 days of discharge. The use of a simple risk scoring model with high generalizability, based on demographics, clinical features, and interventions, can bring refinement to the prediction of 30‐day readmission in high‐risk patients; the Mumtaz readmission risk score highlights the need for targeted interventions in order to decrease rates of readmission within this population.