Early hospital readmission and survival in patients with cirrhosis: A population-based study

Background: Readmission in patients with cirrhosis is common. We aimed to determine the association between early hospital readmission and survival in the general population of patients with cirrhosis. Methods: This retrospective cohort study used routinely collected health care data from Ontario. We identified adults with cirrhosis using a validated case definition, and included those with at least one hospital admission between 1992 and 2016 resulting in discharge. Patients were classified into two groups based on timing of readmission after index admission: 1) ≤90 days, or 2) >90 days or no readmission. We described overall survival (OS) 90 days after the index hospitalization by readmission status using Kaplan–Meier curves and the log-rank test. The association between readmission and OS was evaluated using a multivariate Cox proportional hazards regression model. Results: Our study included 115,081 patients. The median OS was shorter in patients readmitted in ≤90 days (4.1 years, IQR 0.9, 13.1) compared with those readmitted in >90 days or not readmitted during the study period (9.6 years, IQR 3.2, 21.9, p <0.001). Adjusting for potential confounders, those readmitted in ≤90 days had a higher hazard of death than those not readmitted (hazard ratio [HR] 1.56, 95% CI 1.53 to 1.59, p <0.001). Conclusions: Early readmission in patients with cirrhosis is a strong predictor of decreased OS. Our results suggest that patients with cirrhosis who have an early readmission should be further studied to determine whether this risk is modifiable. They can also be used to discuss long-term prognosis with patients and family members.