A217 HOSPITAL RE-ADMISSION IS ASSOCIATED WITH DECREASED SURIVIVAL IN PATIENTS WITH CIRRHOSIS: A POPULATION-BASED STUDY
Bibliographic record
Abstract
Patients with cirrhosis have high rates of hospital re-admission. The association between short-term re-admission and long-term survival at the population level is unknown. Our study aimed to examine the relationship between 30 and 90 day hospital re-admission and overall survival in patients with cirrhosis in Ontario, Canada. Population-based cohort study using the data holdings from the Institute of Comparative Evaluative Sciences from 1992–2015. Individuals with cirrhosis were identified using validated administrative coding algorithms. Those with at least one hospital admission after cirrhosis diagnosis from 1992–2012 resulting in discharge were included with follow-up to 2015. Data on demographics, hospitalizations, and survival were defined using linked administrative datasets. Overall survival (OS) after index hospital discharge was described using Kaplan-Meier curves and the log-rank test. The association between 30 and 90 day hospital re-admission and OS post-discharge were evaluated using multivariate Cox proportional hazards regression. Out of 178,152 patients with cirrhosis, a total of 116,047 had a least one hospital admission resulting in 443,706 unique hospitalization events and formed the cohort; 61% male, median age 58 yrs (IQR 47–68 yrs) and 60% died during a median follow-up of 7.6 yrs (IQR 3.0–14.5 yrs). A single hospital admission was identified in 30% while 5 or more admissions occurred in 27%, median length of stay was 5 days (IQR 2–10 days). The 30 and 90 day re-admission rates were 19.9% and 33.4% respectively. The median OS post-discharge was considerably shorter in patients re-admitted by 30 days (2.6 yrs, 95% CI 0.5–9.7 yrs) or 90 days (3.0 yrs, 95% CI 0.7–10 yrs) compared to those > 90 days/never re-admitted (6.0 yrs years, 95% CI 1.6–16.7 yrs, P < .001). After adjusting for potential confounders, those re-admitted within 30 or 90 days had a higher hazard of death post-discharge then those who were not (HR 1.51, 95% CI 1.48–1.53, P < .001; HR 1.42, 95% CI 1.40–1.44, P < .001 respectively). Other factors associated with decreased OS were a liver-related admission (HR 1.32, 95% CI 1.29–1.34, P <.001), receipt of paracentesis (HR 1.55, 95% CI 1.50–1.59, P <.001), male gender (HR 1.19, 95% CI 1.17–1.22, P < .001), older age (HR 1.20 per 5-yr, 95% CI 1.19–1.20, P < .001) and Charlson score ≥ 4 (HR 2.31 95% CI 2.23–2.39, P < .001). Re-admission at 30 or 90 days in patients with cirrhosis is a strong predictor of a decreased OS. These results can be used when counselling patients and families regarding prognosis and identifying high-risk patients where interventions to prevent re-admission may improve outcomes. Southeastern Ontario Academic Medical Association New Clinician Scientist Award
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".