Data from: Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

Background. Safety-net hospitals provide care for racially/ethnically
diverse and disadvantaged urban populations. Their hospitalized patients
with cirrhosis are relatively understudied and may be vulnerable to poor
outcomes and racial/ethnic disparities. Aims. To examine the outcomes of
patients with cirrhosis hospitalized at regionally diverse safety-net
hospitals and the impact of race/ethnicity. Methods. A study of patients
with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was
conducted. Demographic, clinical factors, and outcomes were compared
between centers and racial/ethnic groups. Study endpoints included
mortality and 30-day readmission. Results. In 2012, 733 of 1,212 patients
with cirrhosis were hospitalized for liver-related indications (median age
55 years, 65% male). The cohort was racially diverse (43% White, 25%
black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral
hepatitis in 635 (87%) patients. Patients were hospitalized mainly for
ascites (35%), hepatic encephalopathy (20%) and gastrointestinal bleeding
(GIB) (17%). Fifty-four (7%) patients died during hospitalization and 145
(21%) survivors were readmitted within 30 days. Mortality rates ranged
from 4 to 15% by center (p=.007 ) and from 3 to 10% by race/ethnicity
(p=.03), but 30-day readmission rates were similar. Mortality was
associated with Model for End-stage Liver Disease (MELD), acute-on-chronic
liver failure, hepatocellular carcinoma, sodium and white blood cell
count. Thirty-day readmission was associated with MELD and Charlson
Comorbidity Index >4, with lower risk for GIB. We did not observe
geographic or racial/ethnic differences in hospital outcomes in the
risk-adjusted analysis. Conclusions. Hospital mortality and 30-day
readmission in patients with cirrhosis at safety-net hospitals are
associated with disease severity and comorbidities, with lower
readmissions in patients admitted for GIB. Despite geographic and
racial/ethnic differences in hospital mortality, these factors were not
independently associated with mortality.