Retrospective Cohort Study
Copyright ©The Author(s) 2017.
World J Gastroenterol. Oct 7, 2017; 23(37): 6868-6876
Published online Oct 7, 2017. doi: 10.3748/wjg.v23.i37.6868
Table 1 ICD-9 codes used to identify patients
Bleeding from esophageal varices456
Esophageal varices in diseases classified elsewhere456.2
Spontaneous bacterial peritonitis567.23
Alcoholic fatty liver571
Alcoholic cirrhosis of liver571.2
Laennec's cirrhosis571.2
Cirrhosis of liver nos571.5
Cirrhosis of liver without mention of alcohol571.5
Macro nodular cirrhosis571.5
Micro nodular cirrhosis571.5
Portal cirrhosis NOS571.5
Posthepatitic cirrhosis571.5
Post necrotic cirrhosis571.5
Cholangitic cirrhosis571.6
Cholestatic cirrhosis571.6
Hepatic encephalopathy572.2
Portal hypertension572.3
Hepatorenal syndrome572.4
Other sequelae of chronic liver disease572.8
Hepatopulmonary syndrome573.5
Ascites789.5
Table 2 Baseline characteristics of cohort (n = 222) n (%)
DemographicsNumber of patients
Male149 (67.2)
White168 (76)
Married82 (36.9)
Agemean ± SD: 56.7 (11.7)
Insurance
Private insurance81 (36.5)
Medicaid or mass health74 (33.3)
Medicare62 (27.9)
No Insurance (self-pay/free care)5 (2.3)
Education
High school/equivalent or less127 (57.2)
Some college and above60 (27)
Not recorded35 (15.8)
Clinical History
Alcohol use
Former heavy use110 (49.5)
No significant history65 (29.3)
Current heavy use47 (21.2)
Smoking
Never smoked82 (36.7)
Former smoker77 (34.7)
Current smoker63 (28.4)
Etiology of cirrhosis
Alcohol83 (37.4)
HCV or HBV (HCV, n = 46)49 (22.1)
Combination of etiologies (mainly HCV + alcohol)40 (18)
NASH29 (13)
Cryptogenic or other etiologies21 (9.5)
Co-morbidities (Top 5)
Mental health (Depression or bipolar disorder)68 (30.2)
Diabetes mellitus65 (29.8)
Coronary artery disease27 (12)
Chronic kidney disease27 (12)
Hepatocellular carcinoma24 (10.6)
Table 3 Hospitalization characteristics n (%)
Index hospitalization
Complication of cirrhosis at index admissionNumber of patients
Volume-related64 (28.8)
Hepatic encephalopathy61 (27.5)
Variceal bleeding54 (24.3)
Spontaneous bacterial peritonitis27 (12.2)
Other or > 1 complication16 (7.2)
mean ± SD
Length of stay7.2 (7.8)
MELD at admission13.3 (7.7)
MELD at discharge12.2 (7.5)
ReadmissionsNumber of patients
Readmitted with the same complication88 (49.4)
Readmitted in one month46 (20.7)
Cause of readmission
Hepatic encephalopathy49 (35.5)
Volume-related38 (27.5)
Variceal bleeding31 (22.5)
Other or > 1 complication12 (8.7)
Spontaneous bacterial peritonitis8 (5.8)
Table 4 Post-discharge follow-up n (%)
Number of patients30-d readmissionsP value
Post-discharge status
Home120 (54.3)19 (15.9)P < 0.12
VNA60 (27.2)14 (23.3)
SNF/rehab or LTAC30 (13.5)8 (26.7)
Eloped5 (2.3)0
Shelter5 (2.3)0
Mental Institute1 (0.4)1(100)
Follow-up outpatient visits
Gastroenterologist83 (37.4)10 (12.1)P = 0.9
PCP22 (9.9)2 (9.1)
Both31 (14)4 (12.9)
Readmitted before visit29 (13.1)29 (100)
Total165 (74.3)45 (27.3)
First post-discharge outpatient follow-up (PCP and/or GI)
< 2 d35 (21.2)31 (60.0)P = 0.1
2-14 d66 (40.0)13 (19.7)
> 14 d64 (38.8)3 (4.7)
Time to visit (d)Mean ± SD
Time to first visit by GI22.6 (43.7)
Time to first visit by PCP31.9 (35)
Time to first visit by PCP or GI24.7 (33.8)
Table 5 Predictors of time to readmission
VariableUnivariate analysis
Multivariate analysis
HRP valueHRP value
(95%CI)(95%CI)
Education level (ref = Some college and above)11.000.021.00
Finished high school and less1.64 (1.02-2.46)0.021.56 (0.98-2.46)0.05
MELD category (ref = MELD < 15 )1.000.0071.00
15 ≤ MELD < 251.45 (0.97-2.15)0.061.52 (1.00-2.31)0.04
MELD ≥ 252.51 (1.33-4.75)0.0042.51 (1.24-5.11)0.01
Etiology of CLD (ref = Alcohol)1.000.031.00
HCV1.74 (1.10-2.76)0.031.73 (1.06-2.82)0.02
NASH/Cryptogenic1.25 (0.76-2.05)0.361.81 (1.02-3.18)0.04
Other/Combination of etiologies1.94 (1.20-3.11)0.0062.02 (1.24-3.29)0.004
History of HCC1.85 (1.10-3.08)0.011.67 (0.95-2.93)0.07
HE1.51 (1.04-2.16)0.011.61 (1.11-2.40)0.01
Table 6 Predictors of 30-d readmission
VariableUnivariate analysis
Multivariate analysis
ORP valueORP value
(95%CI)(95%CI)
Insurance (ref =Medicaid/No insurance)11
Medicare11.8 (1.00 -3.94)0.053.42 (1.3-9.00)0.01
Education (ref = Some college and above)1.001
Finished high school and less23.56 (1.40-9.00)0.0022.62 (1.01-7.12)0.05
ALT > ULN at discharge2.52 (1.29-4.89)0.0062.29 (1.09-5.11)0.03
Hepatic encephalopathy2.17 (1.10-4.29)0.012.34 (1.09-4.80)0.03