A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

Kamesh Gupta, Bandhul Hans, Ahmad Khan, Syed Hamza Sohail, Devika Kapuria, Chris Chang

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM To identify the trend of PC utilization for the special population of alcoholassociated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 (P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-onchronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01). CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade.

Original languageEnglish
Pages (from-to)1817-1829
Number of pages13
JournalWorld Journal of Hepatology
Volume14
Issue number9
DOIs
StatePublished - Sep 27 2022

Keywords

  • Alcohol-associated cirrhosis
  • End stage liver disease
  • National inpatient sample
  • National readmission database
  • Palliative care

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