Palliative Care in Alcoholic Hepatitis: A Nationwide Study of Predictors, Readmission, and Overtime Trends

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Alcoholic hepatitis (AH), a clinical syndrome precipitated by alcohol abuse, can manifest as acute liver failure (ALF) and thus carries a poor prognosis. AH-related hospitalizations constitute about 0.9% of the total admissions nationwide. Palliative care (PC) is gaining increasing recognition in the management of chronic diseases including end-stage liver disease. However, despite the growing recognition of PC across various medical domains, there remains a dearth of data exploring its utilization patterns in AH hospitalizations. Our study aims to explore patterns of PC utilization among AH patients and its impact on readmission. Methods: Using the National Readmission Database 2015-2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications (ICD-10-CM) codes to identify adult patients admitted with AH. The patients were categorized into 2 groups based on whether they had a palliative care encounter (PCE) during the same hospitalization. Using a multivariate regression model, we assessed predictors of PCE and its impact on 90-day readmission. Statistical analysis was performed using STATA version 14.2. Results: We identified 68,062 hospitalizations for AH, of whom 3,784 (5.56%) had PCE in index hospitalization. Analysis showed that North American Consortium for the Study of End-Stage Liver Disease -Acute on Chronic Liver Failure (NACSELD-ACLF) score ≥ 2 was associated with the highest odds of receiving PCE (adjusted odds ratio [aOR] 8.54, P<0.01), followed by metastatic malignancy (aOR 3.72, P=0.04), dementia (aOR 2.69, P=0.04), CKD (aOR 2.50, P<0.01) and admission to large-sized hospitals (aOR 1.66, P=0.03). Readmission analysis of patients discharged alive showed that adjusted 90-day readmission was significantly lower in patients who received index admission PCE (aOR 0.45, P<0.01) (Table 1, Figure 1). The total hospitalization days in case of readmissions within 90 days were 19,655 days, costing $152,000,000 USD. Longitudinal analysis of PCE in AH hospitalizations showed a non-significant change from 5.39% in 2016 to 5.69% in 2020 (trend P-value: 0.07). Conclusion: Our study highlights that PCE is associated with more than 50 % reduction in 90-day readmission rates in AH patients. Despite these promising outcomes, our analysis revealed a static trend in PC utilization over the study period, indicating potential areas for improvement in integrating PC into the comprehensive management of AH patients.

Volume

119

Issue

10

First Page

S1257

Last Page

S1258

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