Abstract
Background & Aims: Cirrhosis-related inpatient hospitalizations have increased dramatically over the past decade. We used a longitudinal dataset capturing a large metropolitan area in the United States from 2011 to 2021 to evaluate contemporary hospitalization rates and risk factors among frail patients with cirrhosis. Methods: We conducted a retrospective, longitudinal cohort study using the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) database, an electronic health record repository that aggregates de-duplicated data across 7 health care systems in the Chicago metropolitan area, from 2011 to 2021. The primary outcome of our study was the rate of hospitalization encounters. Frailty was defined by the Hospital Frailty Risk Score. Hospitalization rates were reported per 100 patients per year, and a multivariable logistic regression analysis identified predictors of annual hospitalization probability. Results: During the study period, of 36,971 patients, 16,265 patients (44%) were hospitalized (compensated, 18.4%; decompensated, 81.6%). Hospitalization rates were highest in patients with decompensated cirrhosis, reaching nearly 77.3 hospitalizations/100 patients per year. Hospitalization rates among patients with compensated cirrhosis were also high (14.2 vs 77.3 hospitalization/100 patients per year), with odds of annual hospitalization 3 times (odds ratio, 3.1; 95% confidence interval, 2.9-3.4) as high among compensated patients with intermediate frailty and 5 times (odds ratio, 5.2; 95% confidence interval, 4.5-6.0) as high among those with severe frailty (compared with compensated patients with low frailty). Conclusion: Compensated and decompensated cirrhosis patients with intermediate to severe frailty face a substantially increased odds of annual hospitalizations compared with those with low frailty. Future work should focus on targeted interventions to incorporate routine frailty screenings into cirrhosis care and to ultimately minimize high hospitalization rates.
| Original language | English (US) |
|---|---|
| Journal | Clinical Gastroenterology and Hepatology |
| DOIs | |
| State | Accepted/In press - 2024 |
Funding
Funding This work was supported by a National Institute on Aging (NIA) sponsored grant \u201CLIVOPT \u2013 LIVer cirrhosis - Optimizing Prediction of Patient OuTcomes\u201D (R01AG070194) (Mohsen Mohammadi, Salva N. Balbale, Mitchell Paukner, Therese Banea, Lisa B. VanWagner, Lihui Zhao, Andres Duarte-Rojo, Julianna Doll, Sanjay Mehrotra, Daniela P. Ladner) and the Transplant Surgery Scientist Training Program (T32DK077662) (Bima J. Hasjim). The views expressed in this article are those of the authors and do not necessarily represent the views of the NIA. We would also like to acknowledge the Northwestern University Transplant Outcomes Research Collaborative (NUTORC), which provided IRB support and coordination.?>Conflicts of interest These authors disclose the following: Lisa B. VanWagner serves as an advisor for Numares, Slingshot Insights, and Gerson Lehrman Group, receives grant support from W.L. Gore & Associates and provides expert witness services outside the submitted work. The remaining authors disclose no conflicts. Funding This work was supported by a National Institute on Aging (NIA) sponsored grant \u201CLIVOPT -- LIVer cirrhosis - Optimizing Prediction of Patient OuTcomes\u201D (R01AG070194) (Mohsen Mohammadi, Salva N. Balbale, Mitchell Paukner, Therese Banea, Lisa B. VanWagner, Lihui Zhao, Andres Duarte-Rojo, Julianna Doll, Sanjay Mehrotra, Daniela P. Ladner) and the Transplant Surgery Scientist Training Program (T32DK077662) (Bima J. Hasjim). The views expressed in this article are those of the authors and do not necessarily represent the views of the NIA. We would also like to acknowledge the Northwestern University Transplant Outcomes Research Collaborative (NUTORC), which provided IRB support and coordination.
Keywords
- Cirrhosis
- Frailty
- Hospitalizations
ASJC Scopus subject areas
- Hepatology
- Gastroenterology