A185 ASSOCIATION BETWEEN SHORT-TERM HOSPITAL READMISSION AND OVERALL SURVIVAL IN PATIENTS WITH CIRRHOSIS: A POPULATION-BASED STUDY
Bibliographic record
Abstract
Readmissions in patients with cirrhosis is common. Whether early readmission is related to long-term survival at the population level is unknown. We aimed to determine the association between early hospital readmission and long-term survival in the general population of patients with cirrhosis. We conducted a retrospective cohort study utilizing routinely collected health care data from Ontario, Canada accessed through the Institute for Clinical Evaluative Sciences. Adults with cirrhosis were identified using a validated coding algorithm and those with at least one hospital admission resulting in discharge between January 1992 and March 2016 were included, with follow-up until December 2016. Patients were classified into three readmission groups: 1) ≤30 days, 2) 31–90 days and 3) >90 days or never readmitted. Overall survival (OS) after index discharge was described using Kaplan-Meier curves and the log-rank test. The association between hospital readmission and OS was evaluated using multivariate Cox proportional hazards regression. 134,610 patients met inclusion criteria. The 30 and 90 day readmission rates were 15.6% and 27.1%, respectively. The median OS post-discharge was considerably shorter in patients readmitted in ≤30 days (2.1 years, IQR 0.2–10.9 years) or 31–90 days (2.9 years, IQR 0.5–11.4 years) compared to those >90 days/never readmitted (10.3 years, IQR 3.3–23.7 years, P<0.001). After adjusting for potential confounders, those readmitted in ≤30 or 31–90 days had a higher hazard of death than those who were not (HR 2.05, 95% CI 2.01–2.09, P<0.001; HR 1.80, 95% CI 1.77–1.85, P<0.001, respectively). Other factors associated with decreased OS were older age (HR 1.05 per year increase, 95% CI 1.05-1.05, P<0.001), male sex (HR 1.34, 95% CI 1.32–1.36, P<0.001), Charlson-Deyo Comorbidity Index score ≥4 (HR 1.85, 95% CI 1.80–1.91, P<0.001), liver-related index admission (HR 1.46, 95% CI 1.42–1.50, P<0.001), paracentesis at index admission (HR 1.71, 95% CI 1.67–1.75, P<0.001), and index admission to a community hospital (HR 1.09, 95% CI 1.07–1.11, P<0.001). Early readmission in patients with cirrhosis is a strong predictor of decreased OS. These results can be used when counselling patients and families regarding prognosis after a short-term readmission. Southeastern Ontario Academic Medical Association New Clinician Scientist Award
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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, unvalidatedLabeled directly by 2 models reading the full record.
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".