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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States
Kamesh Gupta, Bandhul Hans, Ahmad Khan, Syed Hamza Sohail, Devika Kapuria, Chris Chang
Kamesh Gupta, Department of Gastroenterology, UMass Chan Medical School-Baystate, Springfield, MA 01199, United States
Bandhul Hans, Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States
Ahmad Khan, Department of Gastroenterology, Case Western University, Cleveland, OH 44106, United States
Syed Hamza Sohail, Department of Internal Medicine, UMass Chan Medical School-Baystate, Springfield, MA 01199, United States
Devika Kapuria, Department of Gastroenterology, Washington University, St. Louis, MO 63110, United States
Chris Chang, Department of Gastroenterology, University of New Mexico, Alberquerque, NM 46111, United States
Author contributions: Hans B and Gupta K contributed equally to this manuscript and should be considered co-first authors; Chang C and Kapuria D have equal contribution and are joint senior authors; Hans B and Gupta K devised the statistical analysis plan, wrote the statistical code and contributed in writing the manuscript; Kapuria D conceived the study idea and contributed in writing the manuscript; Khan A ran the statistical tests; Sohail SH performed a background literature search; Chang C was our faculty mentor who revised and edited the final manuscript; all authors provided critical feedback and helped shape the research analysis and manuscript.
Institutional review board statement: Since the paper contains data from a nationalized, publicly available, de-identified database, the paper is exempted for institutional review board.
Informed consent statement: Since the paper contains data from a nationalized, publicly available, de-identified database, the paper is exempted for institutional review board. Further, no patient consent was required for the same as no intervention was performed during the study.
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kamesh Gupta, MD, Doctor, Department of Gastroenterology, UMass Chan Medical School-Baystate, 759 Chestnut St, Springfield, MA 01199, United States. kamesh.guptamd@bhs.org
Received: May 18, 2022
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
ARTICLE HIGHLIGHTS
Research background
Use of palliative care (PC) consultation has been steadily increasing, especially in the field of cirrhosis.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
