Trends From 2008 to 2022

TOPLINE:

Adults with cirrhosis make four times more emergency department (ED) visits per year, with post-ED 90-day mortality rates being more than double those of patients with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

METHODOLOGY:

• Researchers analyzed data from Optum’s deidentified Clinformatics® Data Mart Database, covering 38,419,650 patients from 2008 to 2022.
• Patients with cirrhosis (n = 198,439) were compared with those with CHF (n = 1,817,628), those with COPD (n = 2,394,037), and those without cirrhosis (n = 38,221,211). A total of 37,375 patients without cirrhosis developed cirrhosis during the study period.
• ED visits were identified using validated billing code definitions and were classified as liver-related, non–liver-related, or unclassified.
• Post-ED outcomes included 90-day mortality rates and discharge disposition, and models were adjusted for patient- and visit-level characteristics.

TAKEAWAY:

• Patients with cirrhosis made 1.72 ED visits per person-year, compared with 0.46 by those without cirrhosis, 1.66 by those with CHF, and 1.22 by those with COPD.
• The 90-day mortality rates post-ED visit were 12.2%, 4.8%, 6.9%, and 6.3% for patients with cirrhosis, without cirrhosis, with CHF, and with COPD, respectively.
• Non–liver-related ED visits were more likely than liver-related ED visits to lead to discharge to home among patients with compensated (52.8%) and decompensated (42.2%) cirrhosis.
• Patients with cirrhosis who did not have any outpatient follow-up within 30 days post-ED discharge had a higher 90-day mortality rate (22.0%) than those with both primary care and gastroenterology/hepatology follow-ups (7.9%).

IN PRACTICE:

“Patients with cirrhosis have higher ED utilization and almost 2-fold higher post-ED visit mortality than CHF and COPD. These findings provide impetus for ED-based interventions to improve cirrhosis-related outcomes,” the authors wrote.

SOURCE:

The study was led by Hirsh Elhence, AB, Keck School of Medicine, University of Southern California, Los Angeles. It was published online on August 22, 2024, in Clinical Gastroenterology and Hepatology.

LIMITATIONS: 

The study’s reliance on billing codes may have led to misclassification and undercounting of cirrhosis-related admissions. The findings may not be generalizable to underinsured and uninsured populations. The observational nature of the study may have resulted in residual confounding.

DISCLOSURES:

The study was supported by the National Institute on Alcohol Abuse and Alcoholism and the USC Research Center for Liver Diseases. The authors reported 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.