Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1817
Peer-review started: May 18, 2022
First decision: June 23, 2022
Revised: July 4, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: September 27, 2022
Processing time: 119 Days and 9.8 Hours
Use of palliative care (PC) consultation has been steadily increasing, especially in the field of cirrhosis.
Alcohol-associated end stage liver disease (ESLD) patients are at a disadvantage for being referred to palliative care as they are younger and are more likely to belong to lower socioeconomic strata. The use of palliative care is especially important for this subgroup as the only definite treatment is liver transplant which is often not an option for these patients.
To assess the trend of PC use in patients hospitalized with alcohol associated ESLD as the primary diagnosis, study the baseline characteristics of these patients, evaluate the factors associated with increased PC use, study the impact of PC use on hospitalization outcomes and 30-d readmission rates.
We used the national inpatient sample from 2007 to 2014, and the national readmission database from 2010 to 2014. We identified the patients admitted with alcoholic cirrhosis and at least one cirrhosis decompensation event. We identified patients with PC consultation as a secondary diagnosis. Baseline characteristics between the groups were compared with linear regression, and multivariate regression analysis model was used to assess the impact that PC use has on the hospitalization outcomes.
PC use has increased over 8 times during the study period and was used in 6.6% of alcohol-associated ESLD hospitalizations in 2014. PC use was more common in patients with ascites, hepatic encephalopathy and hepatocelluluar carcinoma. Other factors associated with increased PC use were females, whites, uninsured patients, teaching hospitals and patients with a higher North American Consortium for the Study of End-Stage Liver Disease's definition of acute-on-chronic liver failure score. The length of stay and total hospitalization costs were lower in patients with acute-on-chronic liver failure score ≥ 2 and receiving PC, but not significantly different in the overall cohort. PC use was associated with significantly lower 30-d readmission rates, with odds ratios of 0.35.
PC use has been increasing over the years, however is still underutilized especially in select population and in rural areas. We show that PC use is associated with decreased length of stay in patients with more complications, and also leads to decreased 30-d readmission rates.
This study calls for further research to assess the point during the disease course in which patients with alcohol-associated ESLD would benefit from PC use. Further research should also be conducted to assess for the reasons for decreased PC use in select disadvantaged population.