Trends, Predictors, and Outcomes of 30- and 90-Day Readmissions Following Alcoholic Hepatitis: A Nationwide Readmissions Database Study, 2016–2022

Background: Alcoholic hepatitis (AH) is associated with high short-term morbidity and mortality, but contemporary national data on hospital readmissions remain limited. Methods: Using the Nationwide Readmissions Database (2016–2022), we identified adult non-elective AH index admissions and characterized readmission burden, predictors, and outcomes using survey-weighted Cox proportional hazards and Fine-Gray competing risks models. Results: Among 121,984 weighted AH index hospitalizations, 25.0% experienced a 30-day readmission. The most common readmission diagnoses were alcoholic cirrhosis with ascites (18.9%), recurrent alcoholic hepatitis with (12.5%) and without ascites (8.9%), sepsis (11.3%), and alcohol withdrawal (5.7%). Liver-related, other/systemic, and alcohol-related non-liver diagnoses accounted for 53.6%, 36.6%, and 9.8% of 30-day readmissions. Readmissions carried higher in-hospital mortality (8.6% vs. 3.3%; aOR 2.75), longer length of stay (7.1 vs. 6.4 days), higher mean charges ($77,606 vs. $60,491), and higher liver transplantation rates (all p < 0.001). Independent predictors of 30-day readmission included age (HR 0.9954 per additional year, p < 0.001), female sex (HR 1.13), discharge against medical advice (HR 1.89), higher comorbidity burden (Category 4 HR 1.30), diabetes (HR 1.13), chronic kidney disease (HR 1.13), acute kidney injury (HR 1.23), and blood transfusion (HR 1.23). Index ICU admission was paradoxically associated with lower readmission rates (OR 0.77) but higher mortality when readmitted (OR 2.38, p < 0.001). Conclusions: One in four AH survivors experienced a 30-day readmission, predominantly liver-related and carrying nearly threefold higher in-hospital mortality. Readmission risk was concentrated among patients with high comorbidity burden, identifying high-yield targets for early risk stratification and post-discharge intervention.