Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis

Thoetchai (Bee) Peeraphatdit, Patrick S. Kamath, Victor M. Karpyak, Brian Davis, Vivek Desai, Suthat Liangpunsakul, Arun Sanyal, Naga Chalasani, Vijay H. Shah, Douglas A. Simonetto

Research output: Contribution to journalArticle

Abstract

Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.

Original languageEnglish (US)
Pages (from-to)477-485.e5
JournalClinical Gastroenterology and Hepatology
Volume18
Issue number2
DOIs
StatePublished - Feb 2020

Fingerprint

Alcoholic Hepatitis
Rehabilitation
Alcohols
Recurrence
Odds Ratio
Patient Readmission
Self-Help Groups
Tertiary Healthcare
Bilirubin
Tertiary Care Centers
ROC Curve
Alcohol Drinking

Keywords

  • Addiction Treatment
  • Alcohol Abstinence
  • Alcohol Use Disorder
  • Chemical Dependency

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis. / Peeraphatdit, Thoetchai (Bee); Kamath, Patrick S.; Karpyak, Victor M.; Davis, Brian; Desai, Vivek; Liangpunsakul, Suthat; Sanyal, Arun; Chalasani, Naga; Shah, Vijay H.; Simonetto, Douglas A.

In: Clinical Gastroenterology and Hepatology, Vol. 18, No. 2, 02.2020, p. 477-485.e5.

Research output: Contribution to journalArticle

Peeraphatdit, Thoetchai (Bee) ; Kamath, Patrick S. ; Karpyak, Victor M. ; Davis, Brian ; Desai, Vivek ; Liangpunsakul, Suthat ; Sanyal, Arun ; Chalasani, Naga ; Shah, Vijay H. ; Simonetto, Douglas A. / Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis. In: Clinical Gastroenterology and Hepatology. 2020 ; Vol. 18, No. 2. pp. 477-485.e5.
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title = "Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis",
abstract = "Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30{\%} in both cohorts. Alcohol relapse rates were 37{\%} in the test and 34{\%} in the validation cohort. Following hospital discharge, 27 patients (20{\%}) in the test cohort and 19 patients (16{\%}) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39{\%}) in a median follow-up time of 2.8 years and 42 deaths (26{\%}) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95{\%} CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95{\%} CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95{\%} CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95{\%} CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95{\%} CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95{\%} CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.",
keywords = "Addiction Treatment, Alcohol Abstinence, Alcohol Use Disorder, Chemical Dependency",
author = "Peeraphatdit, {Thoetchai (Bee)} and Kamath, {Patrick S.} and Karpyak, {Victor M.} and Brian Davis and Vivek Desai and Suthat Liangpunsakul and Arun Sanyal and Naga Chalasani and Shah, {Vijay H.} and Simonetto, {Douglas A.}",
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TY - JOUR

T1 - Alcohol Rehabilitation Within 30 Days of Hospital Discharge Is Associated With Reduced Readmission, Relapse, and Death in Patients With Alcoholic Hepatitis

AU - Peeraphatdit, Thoetchai (Bee)

AU - Kamath, Patrick S.

AU - Karpyak, Victor M.

AU - Davis, Brian

AU - Desai, Vivek

AU - Liangpunsakul, Suthat

AU - Sanyal, Arun

AU - Chalasani, Naga

AU - Shah, Vijay H.

AU - Simonetto, Douglas A.

PY - 2020/2

Y1 - 2020/2

N2 - Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.

AB - Background & Aims: Patients admitted to the hospital for alcoholic hepatitis (AH) are at increased risk of readmission and death. We aimed to identify factors associated with readmission, alcohol relapse, and mortality. Methods: We performed a retrospective analysis of consecutive patients admitted with AH to a tertiary care hospital from 1999 through 2016 (test cohort, n = 135). We validated our findings in a prospective analysis of patients in a multi-center AH research consortium from 2013 through 2017 (validation cohort, n = 159). Alcohol relapse was defined as any amount of alcohol consumption within 30 days after hospital discharge. Early alcohol rehabilitation was defined as residential or outpatient addiction treatment or mutual support group participation within 30 days after hospital discharge. Results: Thirty-day readmission rates were 30% in both cohorts. Alcohol relapse rates were 37% in the test and 34% in the validation cohort. Following hospital discharge, 27 patients (20%) in the test cohort and 19 patients (16%) in the validation cohort attended early alcohol rehabilitation. There were 53 deaths (39%) in a median follow-up time of 2.8 years and 42 deaths (26%) in a median follow-up time of 1.3 years, respectively. In the test cohort, early alcohol rehabilitation reduced odds for 30-day readmission (adjusted odds ratios [AOR] 0.16; 95% CI, 0.04–0.65; P =.01), 30-day alcohol relapse (AOR, 0.11; 95% CI, 0.02–0.53; P <.001), and death (adjusted hazard ratio [AHR], 0.20; 95% CI, 0.05–0.56; P =.001). In the validation cohort early alcohol rehabilitation reduced odds for 30-day readmission (AOR, 0.30; 95% CI, 0.09–0.98; P =.04), 30-day alcohol relapse (AOR 0.09; 95% CI, 0.01–0.73; P =.02), and death (AHR, 0.20; 95% CI, 0.01–0.94; P =.04). A model combining alcohol rehabilitation and bilirubin identified patients with readmission to the hospital within 30 days with an area under the receiver operating characteristic curve of 0.73. Conclusions: In an analysis from two cohorts of patients admitted with AH, early alcohol rehabilitation can reduce risk of hospital readmission, alcohol relapse, and death and should be considered as a quality indicator in AH hospitalization treatment.

KW - Addiction Treatment

KW - Alcohol Abstinence

KW - Alcohol Use Disorder

KW - Chemical Dependency

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