Original Article

Predictor of 90-Day Readmission Rate for Hepatic Encephalopathy

Authors: Supannee Rassameehiran, MD, Charoen Mankongpaisarnrung, MD, Grerk Sutamtewagul, MD, Saranapoom Klomjit, MD, Ariwan Rakvit, MD, FACG

Abstract

Objectives: The purpose of our study was to identify clinical parameters associated with readmissions within 90 days in patients with hepatic encephalopathy (HE).

Methods: We reviewed electronic medical records of patients admitted between January 1, 2010 and September 30, 2013 at University Medical Center, Lubbock, Texas. Inclusion criteria were admission to the hospital with diagnosis of HE in patients older than 18 years. We compared the patients with readmission within 90 days with patients with no readmission using routine clinical data.

Results: A total of 140 admissions met inclusion criteria; 35% were white, 59.3% were Hispanic, and their mean age was 55.6 ± 10.5 years. The median admission Model for End-Stage Liver Disease score was 15.5 (4–38). Univariate analysis demonstrated that a history of diabetes mellitus, a history of hypertension, prior transjugular intrahepatic portosystemic shunt placement, a history of prior HE, and the use of lactulose posthospitalization were associated with increased readmission rates and the presence of gastrointestinal bleeding was associated with decreased readmission rates ( P < 0.05 for each factor). Multivariate logistic regression demonstrated that history of hypertension ( P = 0.02) predicted an increased readmission rate.

Conclusions: Our study demonstrates that hypertension increased the risk of readmission in patients with HE. More intensive interventions in these patients may decrease readmission rates and improve outcomes.

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