Suboptimal use of inpatient palliative care consultation in alcoholic hepatitis hospitalizations may lead to higher readmissions

Department

Internal Medicine

Document Type

Article

Publication Title

Clinics and Research in Hepatology and Gastroenterology

Abstract

Aims: Alcoholic hepatitis (AH), a clinical syndrome precipitated by chronic alcohol consumption, constitutes about 0.9 % of total admissions in the United States. It presents a wide severity spectrum, from mild disease to severe cases associated with high mortality. Palliative care (PC) is a specialized medical approach focused on enhancing the quality of life for patients with serious or life-threatening illnesses. This study aims to investigate the national trends of palliative care (PC) utilization in AH hospitalizations and its impact on resource utilization.

Methods: We identified adult AH hospitalizations from the Nationwide Readmission Database, further categorized based on PC utilization. Multivariate regression analysis was employed to evaluate the impact of PC on the 90-day readmission rate.

Results: Among the 68,062 AH patients, 3,784 (5.56 %) utilized PC services. PC utilization in AH hospitalizations was associated with a significantly lower 90-day readmission rate (adjusted hazard ratio (aHR) 0.45, P = 0.02). 90-day readmission benefits with PC were persistent on analysis of severe (North American Consortium for the Study of End-Stage Liver Disease-Acute-on-Chronic Liver Failure [NACSELD-ACLF] score ≥1) AH population as well (aHR 0.46, P < 0.01). Trend analysis of PC utilization in AH hospitalizations revealed a non-significant change from 5.39 % in 2016 to 5.69 % in 2020 (P = 0.07).

Conclusion: This study shows that PC utilization in AH hospitalizations reduces readmissions and healthcare burden. We advocate integrating PC into the comprehensive management of AH. Further research is needed to determine the optimal timing and components of PC interventions for AH patients.

First Page

102554

DOI

10.1016/j.clinre.2025.102554

Volume

49

Issue

4

Publication Date

4-1-2025

Medical Subject Headings

Humans; Patient Readmission (statistics & numerical data); Palliative Care (statistics & numerical data); Hepatitis, Alcoholic (therapy); Male; Female; Middle Aged; Adult; Referral and Consultation (statistics & numerical data); Hospitalization; United States; Aged

PubMed ID

39947287

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