TOPLINE:

Although only 7.4% of patients with decompensated cirrhosis included in the study received a palliative care consultation during their initial hospital admission, this intervention was associated with significant reductions in unplanned readmissions at both 30 and 90 days.

METHODOLOGY:

• Decompensated cirrhosis drives recurrent hospitalizations among patients with chronic liver disease, with 5%-7% of patients progressing from compensated to decompensated disease each year, yet palliative care is rarely used and often introduced too late.
• Researchers conducted a retrospective analysis of data between 2010 and 2019 from the National Readmission Database (NRD) to evaluate the effect of palliative care consultations on unplanned readmissions among patients with decompensated cirrhosis.
• Patients were classified into two groups on the basis of receipt of palliative care consultation during their initial admission.
• The primary outcome was the incidence of unplanned 30-day and 90-day readmissions for both groups.

TAKEAWAY:

• Researchers identified 1,630,819 patients with decompensated cirrhosis, of whom only 7.4% (mean age, 62.744 years; 63.4% men) received palliative care, while 92.6% (mean age, 59.299 years; 62.2% men) did not.
• Each additional year of age raised the odds of receiving a palliative care consultation by 3% (odds ratio [OR], 1.03; P < .001).
• Patients with metastatic cancer (OR, 2.83; 95% CI, 2.71-2.96), nonmetastatic solid tumors (OR, 2.37; 95% CI, 2.30-2.45), renal failure (OR, 1.31; 95% CI, 1.28-1.35), or congestive heart failure (OR, 1.17; 95% CI, 1.13-1.21) were significantly more likely to receive a palliative care consultation at the initial admission (P < .001 for all).
• Palliative care consultation was associated with 66% lower odds of 30-day readmission (OR, 0.34) and 73% lower odds of 90-day readmission (OR, 0.27; P < .001 for both).

IN PRACTICE:

“[The study] findings strongly support the integration of PC [palliative care] as a standard component of care for patients with decompensated cirrhosis, aligning with recent AASLD [American Association for the Study of Liver Diseases] guidelines,” the authors of the study wrote.

SOURCE:

This study was led by Aya Akhras, MD, Department of Medicine, HCA Florida Aventura Hospital, Aventura, Florida. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

As a retrospective analysis using standardized diagnostic codes, misclassification in both decompensated cirrhosis and palliative care consultation was possible. The NRD does not capture clinical details such as disease severity scores, which limited the ability to further stratify patients. Additionally, the database only tracks hospitalizations within participating hospitals and states; therefore, readmissions following index hospitalizations outside the database may have been misclassified as index admissions.

DISCLOSURES:

No funding sources were reported in this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.