A58 POPULATION CHARACTERISTICS AND OUTCOMES OF CARE IN PATIENTS WITH DECOMPENSATED CIRRHOSIS ADMITTED TO MEDICAL SERVICES AT THE OTTAWA HOSPITAL
Bibliographic record
Abstract
Patients with decompensated cirrhosis have increased healthcare needs and consequentially greater healthcare utilization. Whether specific types of decompensating events including ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), variceal bleeding (VB), and hepatorenal syndrome (HRS) are associated with greater risk of hospital readmission is unclear. We aim to describe an inpatient cohort admitted with decompensated cirrhosis at a single tertiary care center and evaluate important clinical endpoints including length of stay (LOS), inpatient mortality and 30-day readmission rates (R-30) by presence and type of liver decompensation events. Patients with decompensated cirrhosis admitted to a medical service at TOH between July 2014–2016 were identified using ICD codes. Cirrhosis and decompensating events were confirmed by chart review. Of the 302 patient admissions reviewed to date, 190 were first presentation to TOH with decompensated cirrhosis. Among those, 40.5% consumed alcohol in the prior week, and 62.6% of patients had one or more pre-existing complications of cirrhosis (ascites 53.7%, HE 25.8%, SBP 6.8%, VB 12.6%, HRS 1.1%). The average MELD-Na on admission was 19.2 (SD 6.8) for all unique patients. Admissions were complicated by ascites in 70.5%, HE in 25.5%, VB in 20.5%, SBP in 9.5%, and HRS in 5.8%. Patients with ascites, HE and HRS had significantly longer LOS compared to those without: ascites median LOS 6.9 days (IQR 4.0–17.5, p = 0.025), HE 8.7 (4.5–22.0, p = 0.046), HRS 20.7 (11.7–26.9, p = 0.0022). VB trended towards prolonging LOS but not significantly (median 5.29, IQR 3.28–6.89, p=0.051). SBP did not significantly impact LOS (median 12.1, IQR 4.9–24.0, p = 0.13). R-30 was significantly greater in those with HE (37.5%, p=0.008) compared to those without, while other in-hospital decompensating events did not significantly impact R-30 (ascites 23.9%, p=0.72; SBP 27.8%, p=0.63; HRS 9.1%, p=0.26; VB 18.0%, p=0.65). Pre-existing HE was also a significant predictor of R-30 (34.7%, p=0.026). Overall inpatient mortality rate was 19.0%. Inpatient mortality was greatest in those with an in-hospital diagnosis of HRS (72.7%, p<0.0001), followed by SBP (55.6%, p<0.0001) and ascites (19.0%, p=0.002). Mortality rates were not significantly different in patients with HE and VB compared to those without (18.8%, p=0.89; and 20.5%, p=0.94, respectively). In our cohort, patients admitted with decompensated cirrhosis have high in-hospital mortality, prolonged LOS and increased risk of 30-day readmission. Decompensating events, notably HE, negatively impact hospital outcomes such as LOS and R-30, while HRS, SBP and ascites are associated with increased mortality. Future work will target strategies to improve the care for these patients. None
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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 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".