Clinical and patient-reported predictors of days alive and out of hospital in decompensated cirrhosis
Sai Kiran Kuchana, Eric S. Orman, Kelly Mosesso, Timothy Stump, Patrick O. Monahan, Naga Chalasani, Archita P. DesaiBackground:
Days alive and out of hospital (DAOH) is a patient-centered outcome, but has not been studied in decompensated cirrhosis (DCC). We aimed to quantify DAOH and to identify clinical and patient-reported factors associated with DAOH.
Methods:
Using an ongoing prospective cohort study of adults hospitalized with DCC, DAOH was calculated by subtracting days hospitalized, transplanted, or deceased from 90 days post-discharge from index hospitalization. Univariable and multivariable negative binomial hurdle models were used to identify clinical and patient-reported variables associated with DAOH, where DAOH was treated both as a categorical (any readmission, transplant, death vs. all 90-DAOH) and continuous (proportion of event days) outcome.
Results:
Among 363 adults (median age 54 y; MELD 3.0 score 23), 40% experienced all 90-DAOH while 90-day readmission, death, and transplant occurred in 49%, 21%, 11%, respectively. Mean DAOH was 68.3 (SD: 29.0). In multivariable models, transplant evaluation status (listed vs. not listed/evaluated: OR 7.55,
Conclusions:
DAOH is a holistic, patient-centered outcome for decompensated cirrhosis that integrates readmission, transplantation, and mortality into a single measure of post-discharge burden. By using DAOH and moving beyond readmissions, we show that lower MELD 3.0 and higher patient-reported social well-being were independently associated with more days at home after hospitalization.