Hepatocellular carcinoma confers prolonged hospital admissions but lower 30-day readmission rates when compared to patients with cirrhosis only
Journal Contribution ResearchOnline@JCUAbstract
Background and Aim: Cirrhosis and hepatocellular carcinoma (HCC) are associated with high levels of mortality and morbidity, especially when disease course is punctuated by an acute decompensation event. Population based evaluation of trends in presentations, length of stay (LOS) and time to mortality can help in the development and implementation of effective public health policy. We assessed and compared mortality and morbidity trends for patients experiencing an acute decompensation event with HCC and cirrhosis versus those with cirrhosis and no HCC to identify vulnerable patient populations. Methods: We retrospectively analysed data from 1538 patients with cirrhotic liver disease who presented to Blacktown hospital between 2010 and 2022 with an acute decompensation event; ascites requiring therapeutic intervention, hepatic encephalopathy, hepatic hydrothorax and acute variceal bleeds. LOS, time to death and readmission as well as demographic data were recorded, with comparisons of means between patients with and without HCC. Independent predictors of 30-day readmission were selected for the entire cohort, patients with only cirrhosis and those with HCC. Results: 128 patients (8.3%) had diagnosed HCC at the time of discharge following an acute admission. Patients with HCC were significantly older (61.34 ± 9.72) than those without (58.94 ± 11.75) with significantly more having an aetiology relating to hepatitis C infection (41.41% vs 28.16%, p=0.002). These patients also had significantly longer admissions (8.25 ± 9.02 vs 6.96 ± 9.19, p<0.001) with greater rates of in-hospital mortality (25.00% vs 5.55%, p<0.001). As expected, patients with HCC had higher 90-day mortality (47.65%) than those without (15.60%, p<0.001). 30-day readmission rates were higher in those without HCC (37.66%) than those with (23.21%, p=0.029). For cirrhotics without HCC, younger age, male sex and viral aetiology of disease were associated with readmission, whilst gastroscopy for acute variceal bleeding was protective. There were no predictors for readmission in patients with HCC including BCLC, MELD score, ALBI class and admission or discharge on weekends. Conclusion: Patients with HCC have longer admissions with increased mortality when compared to those with cirrhosis but no HCC. However, those with HCC also had lower 30-day readmission rates. There are no clear predictors for acute hospital representation emphasising the importance of early and regular follow up.
Journal
Journal of Gastroenterology and Hepatology
Publication Name
Journal of Gastroenterology and Hepatology
Volume
39
ISBN/ISSN
1440-1746
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Issue
Suppl. 1
Pages Count
1
Location
Adelaide Convention Centre
Publisher
Wiley-Blackwell
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