Suboptimal use of inpatient palliative care consultation in alcoholic hepatitis hospitalizations may lead to higher readmissions

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology Pub Date : 2025-02-11 DOI:10.1016/j.clinre.2025.102554

Ali Jaan , Syeda Shahnoor , Abdul Moiz Khan , Umer Farooq , Qurat Ul Ain Muhammad , Kamran Qureshi

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引用次数: 0

Abstract

Aims

Alcoholic hepatitis (AH), a clinical syndrome precipitated by chronic alcohol consumption, constitutes about 0.9 % of total admissions in the United States. It presents a wide severity spectrum, from mild disease to severe cases associated with high mortality. Palliative care (PC) is a specialized medical approach focused on enhancing the quality of life for patients with serious or life-threatening illnesses. This study aims to investigate the national trends of palliative care (PC) utilization in AH hospitalizations and its impact on resource utilization.

Methods

We identified adult AH hospitalizations from the Nationwide Readmission Database, further categorized based on PC utilization. Multivariate regression analysis was employed to evaluate the impact of PC on the 90-day readmission rate.

Results

Among the 68,062 AH patients, 3,784 (5.56 %) utilized PC services. PC utilization in AH hospitalizations was associated with a significantly lower 90-day readmission rate (adjusted hazard ratio (aHR) 0.45, P = 0.02). 90-day readmission benefits with PC were persistent on analysis of severe (North American Consortium for the Study of End-Stage Liver Disease-Acute-on-Chronic Liver Failure [NACSELD-ACLF] score ≥1) AH population as well (aHR 0.46, P < 0.01). Trend analysis of PC utilization in AH hospitalizations revealed a non-significant change from 5.39 % in 2016 to 5.69 % in 2020 (P = 0.07).

Conclusion

This study shows that PC utilization in AH hospitalizations reduces readmissions and healthcare burden. We advocate integrating PC into the comprehensive management of AH. Further research is needed to determine the optimal timing and components of PC interventions for AH patients.

查看原文本刊更多论文

酒精性肝炎住院患者姑息治疗咨询不理想可能导致更高的再入院率。

目的：酒精性肝炎（AH）是一种由长期饮酒引起的临床综合征，在美国约占总入院人数的0.9%。它呈现出广泛的严重程度，从轻度疾病到与高死亡率相关的严重病例。姑息治疗（PC）是一种专门的医疗方法，重点是提高患有严重或危及生命的疾病的患者的生活质量。本研究旨在探讨国家缓和疗护（PC）在AH住院治疗中的使用趋势及其对资源利用的影响。方法：我们从全国再入院数据库中确定成人AH住院病例，并根据PC使用率进一步分类。采用多因素回归分析评估PC对90天再入院率的影响。结果：68,062例AH患者中，3,784例（5.56%）使用PC服务。AH住院患者PC利用率与90天再入院率显著降低相关（校正风险比0.45，P=0.02）。在严重的（北美终末期肝病研究协会-急性慢性肝衰竭[NACSELD-ACLF]评分≥1）AH人群中，使用PC的90天再入院获益也持续存在（aHR 0.46, p）。结论：本研究表明，在AH住院患者中使用PC可以减少再入院和医疗负担。我们提倡将PC整合到AH的综合管理中。需要进一步的研究来确定AH患者PC干预的最佳时机和组成部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinics and research in hepatology and gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.30

自引率

3.70%

发文量

198

审稿时长

42 days

期刊介绍： Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct). Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.