Hospital Readmissions Increasing for Patients With Alcoholic Hepatitis

Dushyant S. Dahiya, MD

Sudden decompensation or continued alcohol use following discharge are just some of the reasons why a patient with alcoholic hepatitis (AH) eventually is readmitted to the hospital.

A team, led by Dushyant S. Dahiya, MD, Central Michigan University College of Medicine, identified the biodemographic characteristics, readmission trends and outcomes associated with 30-day readmissions for alcoholic hepatitis.

Alcoholic hepatitis is associated with readmissions secondary to continued alcohol use following patient discharge.

The Study

In the retrospective interrupted trend study, the investigators used data from the National Readmission Database (NRD) for the years 2010, 2012, 2014, 2016, and 2018.

They used this data to identify readmissions within 30-days of index admissions for alcoholic hepatitis using ICD-9-CM and ICD-10-CM codes.

Patients excluded in the study were younger than 18 years and had elective or traumatic readmissions.

The investigators used multivariate regression analysis to calculate the trends for risk-adjusted odds of all-cause 30-day readmission, alcoholic hepatitis specific readmissions, mortality, hospital stay and cost after adjusting for age, gender, Charlson Comorbidity Index, insurance type, mean household income, and hospital characteristics.

The Data

The data show readmissions within 30-days following index hospitalization for alcoholic hepatitis rose dramatically from 1839 in 2010 to 3784 in 2018 (P <0.001).

However, there was a geographic trend observed in the data.

Only metropolitan teaching hospitals saw a significant increase in readmissions (P <0.001).

The same was true for males, but gender distribution was deemed to not be statistically significant.

There was also an increase in comorbidity burden with time for alcoholic hepatitis readmissions.

In addition, the 30-day all-cause readmission rate increased from 18.8% in 2010 to 24.4% in 2018. However, there was no significant trend found following multivariate regression analysis.

There was a significant risk-adjusted trend toward decreasing inpatient mortality from 8.7% in 2010 to 7.4% in 2018 for readmissions within 30 days (P = 0.022).

The total days of hospital stay attributable to alcoholic hepatitis readmissions increased by 132.5% from 11,275 days in 2010 to 26,220 days in 2018 with total attributable hospital costs increasing by 160.9% to over $67 million by 2018.

“From 2010–2018, the 30-day readmissions of AH trended upwards which may in part be attributed to sudden decompensation or continued alcohol use after discharge,” the authors wrote. “However, the risk-adjusted inpatient mortality was on a decline reflecting significant improvement in management.”

Alcoholic Hepatitis and COVID-19

Recently, investigators explored the rising rates of alcohol-associated liver disease (ALD), partly because of an increase in alcohol consumption during the COVID-19 pandemic.

Overall, investigators assessed 51,488 new waiting list registrations and 32,320 deceased donor liver transplants (DDLTs) during the study period. Of that population, the median age was 58.0 years for both pre-COVID-19 waiting list registrants and liver transplant recipients, as well as new waiting list registrants and transplant recipients during COVID-19.

A significant increase in the proportions of waiting list registrations (n = 227, 2.4%) was observed in comparison to the pre-COVID-19 period (138 of 9638 registrations [1.4%]; P < .001) for alcoholic hepatitis.

Similarly, a significant increase was seen in the proportions of DDLTs in the COVID-19 period (n = 185, 3.0%) compared to the pre-COVID period (n = 103, 1.6%; P < .001).

The study, “Alcoholic Hepatitis: A Nationwide Study on the Trends of 30-Day Readmissions from 2010 to 2018,” was published online by ACG.