TOPLINE:
Patients with cirrhosis who frequently visit the emergency department (ED) have a higher mortality rate at 360 days. High ED utilizers (HEDU) are younger and more likely to be White and have alcohol-related liver disease than non-HEDU.
METHODOLOGY:
- Researchers conducted a retrospective cohort study of 2124 adults diagnosed with cirrhosis who visited the ED between January 1, 2021, and December 31, 2021.
- Patient records for demographics, laboratory tests, diagnoses, past ED visits, and completion of investigations during the first 8 hours of the ED visit, among others, were obtained from the clinical data warehouse.
- HEDU were patients who had visited the ED two times or more in the 90 days following the initial ED visit.
- The study outcomes included repeat ED visits, time to return to the ED, repeat hospitalizations, liver transplantation, and/or death following the initial ED visit.
- The most common reasons for the initial ED visit were abdominal pain (21%), shortness of breath (19%), and ascites or volume overload (16%). Overall, 42% of the patients returned to the ED, and 34% were rehospitalized within 90 days.
- The overall 90-day mortality rate was 16%. HEDU returned to the ED sooner (16 days vs 34.5 days; P <.001) and had more hospitalizations (1.4 vs 0.2; P <.001) than non-HEDU within 90 days.
- HEDU also had higher rates of mortality (34% vs 19%; P <.001) and liver transplant at 360 days (2.8% vs 1.3%; P =.042) than non-HEDU.
- The independent predictors of high ED utilization were age, undetermined etiology of cirrhosis at the initial visit, severity of liver disease, and prior ED encounters.
IN PRACTICE:
"Individuals with cirrhosis who visit the ED are at risk of becoming high utilizers, which is linked to higher rates of mortality," the authors wrote.
SOURCE:
The study was led by Swetha Parvataneni, MD, Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana. It was published online on June 24, 2024, in The American Journal of Gastroenterology.
LIMITATIONS:
The study's retrospective design may limit the ability to establish causality. The study cohort was predominantly non-Hispanic and White, limiting the generalizability of the study findings to other racial and ethnic groups.
DISCLOSURES:
Some authors received grants from the David W. Crabb Professorship and Terence Kahn Liver Research Program, National Institutes of Health, National Center for Advancing Translational Sciences, and Clinical and Translational Sciences Award. Two study authors declared having ties outside this work.