Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3426
Peer-review started: April 8, 2019
First decision: April 30, 2019
Revised: May 7, 2019
Accepted: June 8, 2019
Article in press: June 8, 2019
Published online: July 14, 2019
In patients with cirrhosis, hepatic encephalopathy (HE) indicates a poor prognosis despite the use of artificial liver and liver transplantation, presenting as frequent hospitalizations and increased mortality rate.
To determine predictors of early readmission and mid-term mortality in cirrhotic patients discharged after the resolution of HE.
From January to February 2018, 213 patients were enrolled in this observational study assessing all the successive patients with cirrhosis discharged from Department of Gastroenterology and Department of Infectious and Liver Diseases, Second Affiliated Hospital of Chongqing Medical University after the resolution of HE. The patients were followed for 6 mo. For each subject, demographic, clinical, and laboratory variables were assessed at the time of diagnosis of HE, during hospital stay, at discharge, and during follow-up. The primary endpoints were incidence of early readmission and mid-term mortality.
During follow-up, 65 (31%) patients experienced an early readmission. International normalized ratio (INR) [odds ratio (OR) = 2.40; P = 0.003) at discharge independently predicted early readmission. The incidence of early readmission was significantly higher in patients with an INR > 1.62 at discharge than in those with an INR ≤ 1.62 (44% vs 19%; P < 0.001). Model for End-stage Liver Disease (MELD) score (OR = 1.11; P = 0.048) at discharge proved to be an independent predictor of early readmission caused by HE. Hemoglobin (OR = 0.97; P = 0.005) at discharge proved to be an independent predictor of non-early readmission. During 6 months of follow-up, 34 (16%) patients died. Artificial liver use (hazard ratio = 6.67; P = 0.021) during the first hospitalization independently predicted mid-term mortality.
INR could be applied to identify fragile cirrhotic patients, MELD score could be used to predict early relapse of HE, and anemia is a potential target for preventing early readmission.
Core tip: International normalized ratio at discharge predicts 30-d readmission in cirrhotic patients after the resolution of hepatic encephalopathy (HE) and Model for End-stage Liver Disease score at discharge predicts 30-d readmission caused by HE in these patients. Meantime, hemoglobin level at discharge predicts 30-d non-readmission in these patients.