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Risk Trajectories for Readmission and Death After Cirrhosis-Related Hospitalization.

Tansel A, Kramer J, Feng H, El-Serag HB, Kanwal F. Risk Trajectories for Readmission and Death After Cirrhosis-Related Hospitalization. Digestive diseases and sciences. 2019 Jun 1; 64(6):1470-1477.

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INTRODUCTION: Patients hospitalized for cirrhosis are at high risk for readmission and death for the first 30 days following discharge. However, there is no information on how these risks dynamically change over a full year after discharge. Our aim was to determine the absolute risks of first readmission and death and characterize these changes in the first year following hospital discharge. METHODS: We conducted a retrospective cohort study of patients who were hospitalized with cirrhosis at all Veterans Affairs hospitals and discharged home between 01/01/2010 and 12/31/2013. We used separate survival models to determine risk of first readmission and death after hospital discharge. We also examined the absolute daily risks for first readmission and death by day and identified the time required for risks of readmission and death to decline 50% and 75% from maximum values. RESULTS: Of the 38,955 patients who survived index hospitalization for cirrhosis, 23,318 patients (59.9%) had at least one readmission and 11,567 patients (29.7%) died within the first year. Daily risk of readmission was the highest on day 1 (1.23%) and declined 50% by day 71 and 75% by day 260. After 1 year, daily risk of readmission did not plateau. Daily risk of death was the highest on day 1 (0.78%) and declined 50% by day 31 and 75% by day 64. CONCLUSION: The risk of readmission and death after cirrhosis-related hospitalization remains elevated for prolonged periods. Patients and providers should remain vigilant for clinical health deterioration beyond the first 30 days following hospitalization.

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