TITLE:
Adherence to American Association for the Study of Liver Diseases (AASLD) Guidelines and Predictors of Readmission in Cirrhotic Patients: A Single Center Experience
AUTHORS:
Maen M. Masadeh, Ali Zaied, Feroze Hussain, Heidi Spratt, Roger Soloway
KEYWORDS:
Liver Cirrhosis, Readmission, Hepatic Encephalopathy, Ascites
JOURNAL NAME:
Open Access Library Journal,
Vol.2 No.6,
June
4,
2015
ABSTRACT:
Introduction: Liver cirrhosis (LC) is a major cause of mortality and
morbidity in the United States. American Association for the Study of Liver
Disease (AASLD) has developed guidelines for the management of patients with
LC. Methods: We conducted a one-year retrospective chart review study of
patients admitted with LC related complication. Our primary outcome was
adherence to AASLD guidelines for the management of variceal bleeding (VB),
fluid overload and hepatocellular carcinoma (HCC) screening, and secondary
outcome was re-admission rate within 30 days of discharge. Results: A total of
139 patients were reviewed. Majority were males (65%) and Caucasians (65%). The
admission indication was mainly for fluid overload (39%), hepatic
encephalopathy (36%) and VB (27%). The one-month readmission rate was 31%, of
those 47% and 37% were admitted for hepatic encephalopathy and fluid overload
respectively. Periodic screening for HCC was done in only 40% of patients.
Ninety-five percent of patients admitted with VB received PPI, octreotride and
antibiotics. Diet education was only documented in 9% of patients on discharge.
Significant predictors for 30-day readmission included high MELD score,
elevated creatinine, and taking diuretics/lactulose before hospitalization in
addition to shorter length of stay. Conclusion: Compliance with AASLD
guidelines was optimal for patients with VB. Further optimization is required
for HCC screening and patient education. Multiple factors play a role in
readmissions for patients with cirrhosis; this model helps to identify patients
at risk for readmission and opens an area for quality improvement measures to
avoid unnecessary hospitalizations.