ABSTRACT
BACKGROUND: Whether certain clinical or laboratory characteristics are able to differentiate cirrhotic patients with upper gastrointestinal bleeds (UGIB) at high-risk inpatient mortality is unknown. The objective of this study is to elucidate patient factors at presentation that are associated with in-hospital mortality. METHODS: A retrospective analysis of cirrhotic patients presenting with UGIB was performed. Baseline characteristics at admission including demographics, clinical and laboratory characteristics were collected. Factors associated with in-hospital mortality were evaluated with logistic regression analyses. The discriminative power of MELD score was evaluated with the use of area under the receiver operating characteristic (ROC) curve. RESULTS: One hundred and sixteen patients were included in this study. MELD score at presentation was higher in the death cohort (24.0 versus 14.8, P < 0.001) and remained significantly associated with mortality after multivariable adjustment (P < 0.001). ROC analysis of MELD score for death yielded an area under the curve of 0.88. At admission, the death group had lower systolic blood pressure (103 mmHg versus 123 mmHg, P=0.008 and more frequently presented with bright red blood per rectum (46.7% versus 11.9%, P = 0.003). Bilirubin and international normalized ratio were also higher, and albumin was lower in patients who died. CONCLUSIONS: Among cirrhotic patients presenting with UGIB, the severity of symptoms and impairment in hepatic synthetic function is associated with in-hospital mortality. Admission MELD score may be useful in predicting in-hospital mortality.
ABSTRACT
Background: Quality indicators (QIs) exist for the care of patients with cirrhosis. We retrospectively examined the records of patients admitted to a large academic tertiary care centre for adherence to QIs and examined for an association between QI adherence and hospital outcomes. Methods: We conducted a cross-sectional study of all patients with decompensated liver cirrhosis admitted to a large academic tertiary care centre over a 2-year period (2014-2016). Medical records of 522 patients were examined for 17 QIs related to inpatient cirrhosis care and adherence-judged using three different standards: 100% adherence, 70% adherence, or the QI score as a continuous variable. Linear and logistic regression was used to evaluate the association between QI score and length of stay (LOS), 30-day readmissions, and inpatient mortality, respectively. Results: Adherence to QIs was variable (range 20%-95%). Overall, adherence to QIs relating to variceal bleeding was higher than adherence to indicators related to hepatic encephalopathy and spontaneous bacterial peritonitis. There was weak evidence for a decreased odds of 30-day readmission when more QIs were met, regardless of the method used to quantify adherence (100% standard OR 0.53 [95% CI 0.26-1.09, p = .09], 70% standard OR 0.58 [95% CI 0.32-1.06, p = .08], continuous method OR 0.90 [95% CI 0.81-1.01, p = .07]). There was no observed relationship between mortality and QI adherence and equivocal evidence for an association between QI adherence and LOS. Conclusions: Adherence to QIs related to inpatient care of decompensated cirrhosis may be associated with decreased 30-day readmissions.
ABSTRACT
BACKGROUND AND AIM: Acute upper gastrointestinal bleeding (UGIB) in cirrhosis is associated with significant morbidity and mortality and can be classified as acute variceal bleeding (AVB) or non-variceal bleeding (NVB). Differences in mortality, hospital length of stay (LOS), and 30-day readmission have yet to be determined. As such, the study aimed to evaluate differences in these clinical outcomes in cirrhotic patients admitted with UGIB. METHODS: This retrospective study included all cirrhotic patients hospitalized for UGIB who underwent upper endoscopy from July 2014 to July 2016. AVB was defined as the presence of varices on endoscopy with high-risk stigmata such as cherry-red spots. Mortality, intensive care unit admission, hospital LOS, and 30-day hospital readmission were recorded and compared among patients with AVB and NVB. RESULTS: A total of 116 patients with cirrhosis were included, 73 with AVB and 43 with NVB. Patients with NVB were older than those with AVB (60.4 ± 11.1 vs 55.0 ± 9.5, P = 0.006) whereas patients with AVB were more likely to have known esophageal varices (64.4% vs 37.2%, P = 0.007). Patients with AVB and NVB had similar mortality (15.1% vs 9.3%, P = 0.57), hospital LOS (4.9, interquartile range: 3.6-6.9 days vs 5.0, interquartile range: 2.7-8.3 days), and 30-day readmission rates (19.2% vs 30.2%, P = 0.18). Severity of clinical presentation was associated with increased LOS and overall mortality, including the need for intensive care unit admission, but these were not associated with 30-day readmission rates. CONCLUSION: There were no differences in clinical outcomes, including mortality, in cirrhotic patients admitted with AVB and NVB.
