P1191 - Palliative Care in Alcoholic Hepatitis: A Nationwide Study of Predictors, Readmission, and Overtime Trends

Ali Jaan, MD¹, Ashish Dhawan, MBBS², Nosheen Hafeez, MD³, Ammad Javaid. Chaudhary, MD⁴, Laraib Fatima. Sheikh, ⁵, Solomon Fredua, MD⁶, Nenrot Gopep, MBBS⁷, Asmaa Bkhet, MBBCh⁸, Syeda Shahnoor, MBBS⁹, Umer Farooq, MD^10
1Rochester General Hospital, Rochester, NY; ²Gian Sagar Medical College and Hospital, Chandigarh, Chandigarh, India; ³Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; ⁴Henry Ford Health, Detroit, MI; ⁵Lahore Medical and Dental College, Rochester, NY; ⁶American University of Antigua College of Medicine, Coolidge, Saint John, Antigua and Barbuda; ⁷University of Jos, College of Medical Sciences, Jos, Plateau, Nigeria; ⁸Menoufia University, Shebin Elkom, Al Minufiyah, Egypt; ⁹Dow Medical College, Karachi, Sindh, Pakistan; ¹⁰SSM Health Saint Louis University Hospital, St. Louis, MO

Introduction: Alcoholic hepatitis (AH), a clinical syndrome precipitated by alcohol abuse, can manifest as ALF and thus carries a poor prognosis. AH-related hospitalizations constitute about 0.9% of the total admissions nationwide. Palliative care (PC) is gaining increasing recognition in the management of chronic diseases including end-stage liver disease. However, despite the growing recognition of PC across various medical domains, there remains a dearth of data exploring its utilization patterns in AH hospitalizations. Our study aims to explore patterns of PC utilization among AH patients and its impact on readmission.

Methods: Using the National Readmission Database 2015-2020, we employed the International Classification of Diseases, 10^th revision, Clinical Modifications (ICD-10-CM) codes to identify adult patients admitted with AH. The patients were categorized into two groups based on whether they had a palliative care encounter (PCE) during the same hospitalization. Using a multivariate regression model, we assessed predictors of PCE and its impact on 90-day readmission. Statistical analysis was performed using STATA version 14.2.

Results: We identified 68,062 hospitalizations for AH, of whom 3,784 (5.56%) had PCE in index hospitalization. Analysis showed that North American Consortium for the Study of End-Stage Liver Disease -Acute on Chronic Liver Failure (NACSELD-ACLF) score ≥ 2 was associated with the highest odds of receiving PCE (adjusted odds ratio [aOR] 8.54, P< 0.01), followed by metastatic malignancy (aOR 3.72, P=0.04), dementia (aOR 2.69, P=0.04), CKD (aOR 2.50, P< 0.01) and admission to large-sized hospitals (aOR 1.66, P=0.03). Readmission analysis of patients discharged alive showed that adjusted 90-day readmission was significantly lower in patients who received index admission PCE (aOR 0.45, P< 0.01) (Table 1, Figure 1). The total hospitalization days in case of readmissions within 90 days were 19655 days, costing 152,000,000 U.S. dollars. Longitudinal analysis of PCE in AH hospitalizations showed a non-significant change from 5.39% in 2016 to 5.69% in 2020 (trend P-value: 0.07).

Discussion: Our study highlights that PCE is associated with more than 50 % reduction in 90-day readmission rates in AH patients. Despite these promising outcomes, our analysis revealed a static trend in PC utilization over the study period, indicating potential areas for improvement in integrating PC into the comprehensive management of AH patients.



Disclosures:


Ali Jaan, MD¹, Ashish Dhawan, MBBS², Nosheen Hafeez, MD³, Ammad Javaid. Chaudhary, MD⁴, Laraib Fatima. Sheikh, ⁵, Solomon Fredua, MD⁶, Nenrot Gopep, MBBS⁷, Asmaa Bkhet, MBBCh⁸, Syeda Shahnoor, MBBS⁹, Umer Farooq, MD¹⁰. P1191 - Palliative Care in Alcoholic Hepatitis: A Nationwide Study of Predictors, Readmission, and Overtime Trends, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.