Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

V. V.Pavan Kedar Mukthinuthalapati, Samuel Akinyeye, Zachary P. Fricker, Moinuddin Syed, Eric Orman, Lauren Nephew, Eduardo Vilar-Gomez, James Slaven, Naga Chalasani, Maya Balakrishnan, Michelle T. Long, Bashar M. Attar, Marwan Ghabril

Research output: Contribution to journalArticle

Abstract

Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safety-net hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%) patients. Patients were hospitalized mainly for ascites (35%), hepatic encephalopathy (20%) and gastrointestinal bleeding (GIB) (17%). Fifty-four (7%) patients died during hospitalization and 145 (21%) survivors were readmitted within 30 days. Mortality rates ranged from 4 to 15% by center (p = .007) and from 3 to 10% by race/ethnicity (p = .03), but 30-day readmission rates were similar. Mortality was associated with Model for End-stage Liver Disease (MELD), acute-on-chronic liver failure, hepatocellular carcinoma, sodium and white blood cell count. Thirty-day readmission was associated with MELD and Charlson Comorbidity Index >4, with lower risk for GIB. We did not observe geographic or racial/ethnic differences in hospital outcomes in the risk-adjusted analysis. Conclusions Hospital mortality and 30-day readmission in patients with cirrhosis at safety-net hospitals are associated with disease severity and comorbidities, with lower readmissions in patients admitted for GIB. Despite geographic and racial/ethnic differences in hospital mortality, these factors were not independently associated with mortality.

Original languageEnglish (US)
Article numbere0211811
JournalPLoS ONE
Volume14
Issue number3
DOIs
StatePublished - Mar 1 2019

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Safety-net Providers
nationalities and ethnic groups
Hospitalization
Fibrosis
Liver
Patient Readmission
End Stage Liver Disease
Mortality
ethnic differences
hemorrhage
Hemorrhage
Hospital Mortality
Comorbidity
liver diseases
Urban Population
Hepatic Encephalopathy
viral hepatitis
Vulnerable Populations
Risk analysis
liver failure

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals. / Mukthinuthalapati, V. V.Pavan Kedar; Akinyeye, Samuel; Fricker, Zachary P.; Syed, Moinuddin; Orman, Eric; Nephew, Lauren; Vilar-Gomez, Eduardo; Slaven, James; Chalasani, Naga; Balakrishnan, Maya; Long, Michelle T.; Attar, Bashar M.; Ghabril, Marwan.

In: PLoS ONE, Vol. 14, No. 3, e0211811, 01.03.2019.

Research output: Contribution to journalArticle

Mukthinuthalapati, VVPK, Akinyeye, S, Fricker, ZP, Syed, M, Orman, E, Nephew, L, Vilar-Gomez, E, Slaven, J, Chalasani, N, Balakrishnan, M, Long, MT, Attar, BM & Ghabril, M 2019, 'Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals', PLoS ONE, vol. 14, no. 3, e0211811. https://doi.org/10.1371/journal.pone.0211811
Mukthinuthalapati, V. V.Pavan Kedar ; Akinyeye, Samuel ; Fricker, Zachary P. ; Syed, Moinuddin ; Orman, Eric ; Nephew, Lauren ; Vilar-Gomez, Eduardo ; Slaven, James ; Chalasani, Naga ; Balakrishnan, Maya ; Long, Michelle T. ; Attar, Bashar M. ; Ghabril, Marwan. / Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals. In: PLoS ONE. 2019 ; Vol. 14, No. 3.
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abstract = "Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safety-net hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65{\%} male). The cohort was racially diverse (43{\%} White, 25{\%} black, 22{\%} Hispanic, 3{\%} Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87{\%}) patients. Patients were hospitalized mainly for ascites (35{\%}), hepatic encephalopathy (20{\%}) and gastrointestinal bleeding (GIB) (17{\%}). Fifty-four (7{\%}) patients died during hospitalization and 145 (21{\%}) survivors were readmitted within 30 days. Mortality rates ranged from 4 to 15{\%} by center (p = .007) and from 3 to 10{\%} by race/ethnicity (p = .03), but 30-day readmission rates were similar. Mortality was associated with Model for End-stage Liver Disease (MELD), acute-on-chronic liver failure, hepatocellular carcinoma, sodium and white blood cell count. Thirty-day readmission was associated with MELD and Charlson Comorbidity Index >4, with lower risk for GIB. We did not observe geographic or racial/ethnic differences in hospital outcomes in the risk-adjusted analysis. Conclusions Hospital mortality and 30-day readmission in patients with cirrhosis at safety-net hospitals are associated with disease severity and comorbidities, with lower readmissions in patients admitted for GIB. Despite geographic and racial/ethnic differences in hospital mortality, these factors were not independently associated with mortality.",
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T1 - Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

AU - Mukthinuthalapati, V. V.Pavan Kedar

AU - Akinyeye, Samuel

AU - Fricker, Zachary P.

AU - Syed, Moinuddin

AU - Orman, Eric

AU - Nephew, Lauren

AU - Vilar-Gomez, Eduardo

AU - Slaven, James

AU - Chalasani, Naga

AU - Balakrishnan, Maya

AU - Long, Michelle T.

AU - Attar, Bashar M.

AU - Ghabril, Marwan

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safety-net hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%) patients. Patients were hospitalized mainly for ascites (35%), hepatic encephalopathy (20%) and gastrointestinal bleeding (GIB) (17%). Fifty-four (7%) patients died during hospitalization and 145 (21%) survivors were readmitted within 30 days. Mortality rates ranged from 4 to 15% by center (p = .007) and from 3 to 10% by race/ethnicity (p = .03), but 30-day readmission rates were similar. Mortality was associated with Model for End-stage Liver Disease (MELD), acute-on-chronic liver failure, hepatocellular carcinoma, sodium and white blood cell count. Thirty-day readmission was associated with MELD and Charlson Comorbidity Index >4, with lower risk for GIB. We did not observe geographic or racial/ethnic differences in hospital outcomes in the risk-adjusted analysis. Conclusions Hospital mortality and 30-day readmission in patients with cirrhosis at safety-net hospitals are associated with disease severity and comorbidities, with lower readmissions in patients admitted for GIB. Despite geographic and racial/ethnic differences in hospital mortality, these factors were not independently associated with mortality.

AB - Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safety-net hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%) patients. Patients were hospitalized mainly for ascites (35%), hepatic encephalopathy (20%) and gastrointestinal bleeding (GIB) (17%). Fifty-four (7%) patients died during hospitalization and 145 (21%) survivors were readmitted within 30 days. Mortality rates ranged from 4 to 15% by center (p = .007) and from 3 to 10% by race/ethnicity (p = .03), but 30-day readmission rates were similar. Mortality was associated with Model for End-stage Liver Disease (MELD), acute-on-chronic liver failure, hepatocellular carcinoma, sodium and white blood cell count. Thirty-day readmission was associated with MELD and Charlson Comorbidity Index >4, with lower risk for GIB. We did not observe geographic or racial/ethnic differences in hospital outcomes in the risk-adjusted analysis. Conclusions Hospital mortality and 30-day readmission in patients with cirrhosis at safety-net hospitals are associated with disease severity and comorbidities, with lower readmissions in patients admitted for GIB. Despite geographic and racial/ethnic differences in hospital mortality, these factors were not independently associated with mortality.

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