Predictors of 1-month and 3-month readmissions among patients with decompensated liver cirrhosis admitted at Muhimbili National Hospital

Abstract

ABSTRACT Background: Cirrhosis is the end stage of chronic liver disease and is associated with substantial inpatient morbidity and mortality. In Tanzania, Cirrhosis is the 13th most common cause of death. It contributes significantly to morbidity due to complications and frequent readmissions shortly after discharge. This study aims to determine the burden of 1-month and 3 month readmission rates and associated factors in our setting Objective: To determine the predictors of 1-month and 3-month readmissions among patients with Decompensated liver cirrhosis admitted in the Gastro-hepatology unit at Muhimbili National Hospital. Methodology: This prospective cohort study was carried out at Muhimbili National Hospital involving a minimum of 110 consenting patients with decompensated liver cirrhosis who were admitted to the gastro-hepatology unit between August and November 2023 and followed up for 3 months post-discharge. Data regarding demographics, laboratory, and disease risk factors were compiled using a structured questionnaire. Continuous variables were summarized as medians (interquartile range) and categorical variables were displayed as percentages. Comparison was done using the Kruskal Wallis test for continuous variables the Chi-squared test and Fisher exact test for categorical variables. The Robust Poisson regression model was used to analyze for factors associated with readmission within 1 and 3 months. A P value of 0.05 was used to denote statistical significance. Results: Of the 110 enrolled patients' males were 71.8%. The overall median age was 44.5, with IQR [36-59] years. The predominant etiology of cirrhosis was alcohol found in 38.2% of patients, and the most common decompensating event responsible for index hospitalization was ascites (68.2%) followed by upper GI bleed (66.4%). About 66.4% of the patients presented with 2 complications at index hospitalization with an average median MELD-Na score of 23, IQR [17 30].1-month and 3-month readmission rates in our study were 20.9% and 30.9% respectively. Factors independently associated with 1-month readmission were MELD-Na (p=0.029) and for 3 months MELD-Na score (p=0.006) and thrombocytopenia (p=0.023). Conclusion and Recommendation: Our study found a comparable burden of readmission at 1- month and 3-months. The identification of the MELD-Na score and thrombocytopenia as factors associated with readmission provides valuable insight into risk factors for poor outcomes in cirrhotic patients. These findings suggest the utilization of the MELD-Na score in our clinical practice in identifying those with the likelihood of being readmitted to improve their outcomes.