MELD-Na scores higher at 30-day readmission for decompensated cirrhosis during pandemic
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CHICAGO — Patients readmitted to the hospital within 30 days for decompensated cirrhosis during the COVID-19 pandemic had fewer comorbidities but increased MELD-Na scores, according to data at Digestive Disease Week.
“Patients with decompensated cirrhosis have a high rate of hospital readmission and mortality,” Michelle Y. Shi, MD, a board-certified internist at the Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, said during a poster presentation. “Many studies available in the literature are focusing on readmissions reported prior to the COVID-19 pandemic.”
In a retrospective study, Shi and colleagues aimed to characterize 30-day readmission of patients with decompensated cirrhosis before (November 2018-February 2020) and during (June 2020-September 2021) the COVID-19 pandemic. They reviewed electronic medical records of 80 and 155 readmissions, respectively, and collected baseline demographic data, etiologies for readmission, comorbidities, cirrhosis-related complications, lab values and MELD-Na scores.
According to analysis, the most common etiologies for cirrhosis among patients before and after the pandemic were alcohol-associated liver disease (60% vs. 61%) and nonalcoholic fatty liver disease (23% vs. 15%). The most common causes for readmission were fluid overload or ascites (31% vs. 24%) and encephalopathy (23% vs. 24%).
In addition, patients readmitted before the pandemic were more likely to have heart failure (OR = 2.72; 95% CI, 1.39-5.35), at least stage 4 chronic kidney disease (OR = 2.47; 95% CI, 1.34-4.54), BMI greater than 30 (OR = 2.61; 95% CI, 1.42-4.78), esophageal varices (OR = 1.99; 95% CI, 1.15-3.44) and infections other than spontaneous bacterial peritonitis (OR = 2.44; 95% CI, 1.26-4.73).
Patients readmitted during the pandemic were more likely not to adhere to medication (6% vs. 24%; OR = 0.21; 95% CI, 0.08-0.57) and had a greater increase in MELD-Na score on readmission (mean increase: 1.79 vs. 3.37).
“In our study, patients who had a 30-day readmission for decompensated cirrhosis during the COVID-19 pandemic had fewer comorbidities but a greater degree of interval increase in readmission MELD-sodium scores,” Shi concluded. “More commonly, the readmissions were associated with inter-admissions medication nonadherence during the pandemic.
“Further studies are warranted to validate observations and to develop strategies to prevent readmissions as the impact of the pandemic remains to be a potential burden on health system.”
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Shi MY, et al. Poster EP99: The characteristics of the 30-day readmission of patients with decompensated cirrhosis before and during the COVID-19 pandemic. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid).
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