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cirrhosis readmission

C Acharya, N S Betrapally, P M Gillevet, R K Sterling, H Akbarali, M B White, D Ganapathy, A Fagan, M Sikaroodi, J S Bajaj
BACKGROUND: Opioid use is epidemic in cirrhosis, which could precipitate hepatic encephalopathy (HE) potentially through gut dysbiosis and inflammation. AIM: To define the effect of opioids on readmissions and on gut microbiota composition and functionality. METHODS: Cohort 1 had 200 cirrhotic in-patients (with/without opioid use) followed prospectively through the index hospitalisation and 6 months post discharge. Readmissions (HE-related/unrelated) were compared between patients discharged on opioids compared to the rest, including using a multi-variable analysis...
January 2017: Alimentary Pharmacology & Therapeutics
Sanath Allampati, Kevin D Mullen
Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with decompensated liver disease. The spectrum of disease ranges from trivial abnormalities in complex decision-making and prolonged reaction time to coma in its most severe form. The very initial stages, recently termed covert hepatic encephalopathy, can only be diagnosed with the help of neuropsychiatric testing, while the later and more severe forms, termed overt hepatic encephalopathy, can be diagnosed clinically. Management of HE is very critical as it can dramatically increase morbidity and mortality...
December 2016: Minerva Gastroenterologica e Dietologica
Pradeep R Atla, Muhammad Y Sheikh, Firdose Gill, Rabindra Kundu, Jayanta Choudhury
BACKGROUND: Hospital re-admissions in decompensated cirrhosis are associated with worse patient outcomes. Hispanics have a disproportionately high prevalence of hepatitis C virus (HCV)-related morbidity and mortality. The goal of this study was to evaluate the factors affecting re-admission rates among Hispanics with HCV-related cirrhosis. METHODS: A total of 292 consecutive HCV-related cirrhosis admissions (Hispanics 189, non-Hispanics 103) from January 2009 to December 2012 were retrospectively reviewed; 132 were cirrhosis-related re-admissions...
October 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Joshua C Rozell, P Maxwell Courtney, Jonathan R Dattilo, Chia H Wu, Gwo Chin Lee
BACKGROUND: Improved pain management and early mobilization protocols have increased interest in the feasibility of short stay (<24 hours) or outpatient total hip (THA) and total knee (TKA) arthroplasty. However, concerns exist regarding patient safety and readmissions. The purposes of this study were to determine the incidence of in-hospital complications following THA/TKA, to create a model to identify comorbidities associated with the risk of developing major complications >24 hours postoperatively, and to validate this model against another consecutive series of patients...
September 1, 2016: Journal of Arthroplasty
Isabel Graupera, Elsa Solà, Núria Fabrellas, Rebeca Moreira, Cristina Solé, Patricia Huelin, Gloria de la Prada, Elisa Pose, Xavier Ariza, Alessandro Risso, Sonia Albertos, Manuel Morales-Ruiz, Wladimiro Jiménez, Pere Ginès
UNLABELLED: MCP-1 (monocyte chemoattractant protein-1) is a proinflammatory cytokine involved in chemotaxis of monocytes. In several diseases, such as acute coronary syndromes and heart failure, elevated MCP-1 levels have been associated with poor outcomes. Little is known about MCP-1 in cirrhosis. AIM: To investigate the relationship between MCP-1 and outcome in decompensated cirrhosis. METHODS: Prospective study of 218 patients discharged from hospital after an admission for complications of cirrhosis...
2016: PloS One
Andrew M Moon, Jason A Dominitz, George N Ioannou, Elliott Lowy, Lauren A Beste
BACKGROUND & AIMS: Prophylactic antibiotics are recommended for all patients with cirrhosis hospitalized for upper gastrointestinal bleeding (UGIB). We evaluated the association between use of antibiotics, outcomes of re-admissions, and mortality in these patients. METHODS: We performed a retrospective study of 6451 patients with cirrhosis (mean age, 60.6 y) in the Veterans Affairs health care system hospitalized for UGIB from January 1, 2005, through December 31, 2013 (8655 hospitalizations)...
November 2016: Clinical Gastroenterology and Hepatology
Scott T Micek, Maanasi Samant, Thomas Bailey, Yixin Chen, Chenyang Lu, Kevin Heard, Marin H Kollef
INTRODUCTION: Clinical deterioration alerts (CDAs) are increasingly employed to identify deteriorating patients. METHODS: We performed a retrospective study to determine whether CDAs predict 30-day readmission. Patients admitted to 8 general medicine units were assessed for all-cause 30-day readmission. RESULTS: Among 3015 patients, 567 (18.8%) were readmitted within 30 days. Patients triggering a CDA (n = 1141; 34.4%) were more likely to have a 30-day readmission (23...
June 3, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Sakkarin Chirapongsathorn, Jayant A Talwalkar, Patrick S Kamath
After the Patient Protection and Affordable Care Act or "Obamacare" was signed into law in 2010, the problem of readmission has taken on a new sense of urgency. Hospitals with excess readmissions receive reduced reimbursement because readmission is considered to represent a poor quality measure in the healthcare delivery system. Cirrhosis places a major burden on the healthcare economy. Patients with cirrhosis frequently require hospitalization, and annual admission rates have doubled within 10 years. The costs of hospitalization associated with cirrhosis have also markedly increased...
May 2016: Seminars in Liver Disease
Gregory D Brown, Andrew J Muzyk, Xavier A Preud'homme
A 59-year-old man with nonalcoholic steatohepatitis cirrhosis underwent an orthotopic liver transplant and experienced a complicated postoperative course, including a prolonged delirium. After discharge to rehabilitation, he had 2 subsequent admissions for delirium. On the first readmission, the transplant team started the patient on risperidone and resumed treatment with sertraline. On his second readmission, neurology and psychiatry were consulted. On evaluation, the patient demonstrated signs of catatonia...
March 2016: Journal of Psychiatric Practice
Elliot B Tapper, Brian Halbert, Jessica Mellinger
BACKGROUND & AIMS: There have been few population-based studies of the rates of and reasons for readmission to the hospital within 30 days among patients with cirrhosis. METHODS: We identified all adult patients with cirrhosis who were admitted in 2011 to hospitals in California, Florida Massachusetts, Mississippi, New York, and Washington (119,722 unique index admissions with cirrhosis). We analyzed data from the State Inpatient Databases, which are longitudinal all-payer databases...
August 2016: Clinical Gastroenterology and Hepatology
Sakkarin Chirapongsathorn, Jayant A Talwalkar, Patrick S Kamath
Patients with cirrhosis are at risk for several complications that require readmission. Readmissions are a direct burden on the patient and the family and are associated with negative outcomes to the patient, family, and health care system. Several recent studies have shown a high rate of readmission in patients with cirrhosis and a trend towards an increase in cost of health care delivery. Physicians and hospitals should recognize the patient at high risk for readmission not only at dismissal from hospital but also at admission...
June 2016: Current Treatment Options in Gastroenterology
Fasiha Kanwal, Steven M Asch, Jennifer R Kramer, Yumei Cao, Sumeet Asrani, Hashem B El-Serag
UNLABELLED: Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013...
August 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Staffan Wahlin
Hepatic encephalopathy causes significant impairment and morbidity. Hepatic encephalopathy is just one of many causes for altered mental status in patients with cirrhosis of the liver. The initial management at admission to hospital includes a search for differential diagnoses and precipitating factors. A structured description of the type, cause, time course and clinical severity is essential for achieving medically safe communication and care of the HE patient. Lactulose and correction of any precipitating factors is the basis for initial therapy...
2016: Läkartidningen
Jung Yeon Lee, Young Hoon Kim, Young Hoon Roh, Kyung Bin Roh, Kwan Woo Kim, Sung Hwa Kang, Yang Hyun Baek, Sung Wook Lee, Sang Young Han, Hee Jin Kwon, Jin Han Cho
PURPOSE: This retrospective study was an investigation of overall survival (OS), disease-free survival (DFS) and prognostic factors affecting OS and DFS in cirrhotic patients who received intraoperative radiofrequency ablation (IORFA). METHODS: Between April 2009 and November 2013, 112 patients (94 men, 84%; 18 women, 16%) underwent IORFA for 185 cases of hepatocellular carcinomas (HCC). Repeat IORFA was done in 9 patients during the same period (total of 121 treatments)...
March 2016: Annals of Surgical Treatment and Research
Wen-Chien Fan, Chia-Chang Huang, Ying-Ying Yang, Alan Lin, Kuei-Chuan Lee, Yun-Cheng Hsieh, Chang-Phone Fung, Hui-Chi Hsu, Ming-Chih Hou, Han-Chieh Lin
BACKGROUND: Pentraxin-3 (PTX3) and soluble tumor necrosis factor (TNF)-like weak inducer of apoptosis (sTWEAK) are new candidate prognostic markers for comorbidities and mortality in various inflammatory diseases. Acute decompensation of cirrhosis is characterized by acute exacerbation of chronic systemic inflammation. Recently, increased circulating PTX3 levels have been reported in nonalcoholic steatohepatitis patients and positively correlated with disease severity. This study aims to explore serum PTX3/sTWEAK levels and their relationship with clinical outcomes in cirrhotic patients with acute decompensation...
January 18, 2016: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Robert S Rahimi, Don C Rockey
Hepatic encephalopathy (HE) is a major complication in patients with decompensated cirrhosis, leading to higher readmission rates causing a profound burden of disease and considerable health care costs. Because ammonia is thought to play a crucial role in the pathogenesis of HE, therapies directed at reducing ammonia levels are now being aggressively developed. Ammonia scavengers such as AST-120 (spherical carbon adsorbent), glycerol phenylbutyrate, sodium phenylacetate or sodium benzoate, and ornithine phenylacetate have been used to improve HE symptoms...
February 2016: Seminars in Liver Disease
Elliot B Tapper
No abstract text is available yet for this article.
July 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Archita P Desai, Nancy Reau
Advanced liver disease is becoming more prevalent in the United States. This increase has been attributed largely to the growing epidemic of nonalcoholic fatty liver disease and an aging population infected with hepatitis C. Complications of cirrhosis are a major cause of hospital admissions and readmissions. It is important to target efforts for preventing rehospitalization toward patients with cirrhosis who are at the highest risk for readmission, such as those who have high Model for End-Stage Liver Disease scores, are at risk for fluid/electrolyte abnormalities or overt hepatic encephalopathy recurrence, and those who have comorbid conditions (e...
2016: Hospital Practice (Minneapolis)
Suong Le, Tim Spelman, Chia-Pei Chong, Phil Ha, Lukas Sahhar, Julian Lim, Tony He, Neel Heerasing, William Sievert
OBJECTIVES: The diagnosis of cirrhotic ascites is associated with significant morbidity, mortality, and reduced health-related quality of life. Adherence by health professionals to quality indicators (QIs) of care for ascites is low. We evaluated the effect of adherence to ascites QIs on clinical outcomes for patients hospitalized with new onset cirrhotic ascites. METHODS: The medical records of 302 patients admitted with new onset cirrhotic ascites were interrogated for demographic and clinical data and adherence to eight Delphi panel-derived QIs for ascites management...
January 2016: American Journal of Gastroenterology
M A Elfeki, R Paz-Fumagalli, A M Tiemeier, S Pungpapong, D M Sella, G T Frey, K R Musto, J H Nguyen, D M Harnois
BACKGROUND: Complications of cirrhosis may persist after liver transplantation. When indicated, partial splenic embolization (PSE) is an alternative to splenectomy but can cause severe infection. The identification of modifiable risk factors when performing PSE in immunocompromised liver transplant recipients may help reduce the risk of severe infection. METHODS: Data were collected retrospectively for all PSE performed after liver transplantation at a single institution and included demographics, etiology of liver disease, indication for PSE, vaccination status, laboratory findings, procedural details, extent and pattern of splenic infarction, hospital length-of-stay, readmissions, procedural complications, and mortality...
December 2015: Transplantation Proceedings
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