A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

Table 1 Baseline characteristics of cohort

Variable	Overall	Patients with palliative consult	Patients without palliative consult	P value
Number of patients	973246	47423	925823
Patient characteristics
Female	276401 (28.4%)	14037 (29.6%)	262933 (28.4%)	< 0.001
Age in yr	54.7 ± 004	57.2 ± 0.1	54.5 ± 0.04	< 0.001
Age divided into categories
18-35	36010 (3.7%)	1327 (2.8%)	33329 (3.6%)	< 0.001
36-45	108030 (11.1%)	3604 (7.4%)	103692 (11.2%)	< 0.001
46-65	625797 (64.3%)	28975 (61.1%)	595304 (64.3%)	< 0.001
> 66	204381 (21%)	13136 (27.7%)	191645 (20.7%)	< 0.001
Race
White	660834 (67.2%)	33433 (70.5%)	614746 (66.4%)	< 0.001
Black	96351 (9.9%)	4647 (9.8%)	95359 (10.3%)	< 0.001
Hispanic	160585 (16.5%)	6544 (13.8%)	161093 (17.4%)	< 0.001
Other	60341 (6.2%)	2940 (6.2%)	57401 (6.2%)	0.532
Charleston comorbidity index
0 or 1	118736 (12.2%)	2371 (5%)	116653 (12.6%)	< 0.001
2	46715 (4.1%)	948 (2%)	38884 (4.2%)	< 0.001
3 or more	854509 (87.8%)	45051 (95%)	809169 (87.4%)	< 0.001
Median income in patient zip code
$1–$38999	297813 (30.6%)	13894 (29.3%)	283301 (30.6%)	0.003
$39000–$47999	255963 (26.3%)	12946 (27.3%)	245343 (26.5%)	0.004
$48000–$62999	231632 (23.8%)	11144 (23.5%)	220345 (23.8%)	0.133
> $63000	187836 (19.3%)	9389 (19.8%)	178683 (19.3%)	< 0.001
Insurance provider
Medicare	341609 (35.1%)	17878 (37.7%)	328667 (35.5%)	< 0.001
Medicaid	260829 (26.8%)	12045 (25.4%)	249046 (26.9%)	< 0.001
Private	255963 (26.3%)	12282 (25.9%)	243491 (26.3%)	< 0.001
Uninsured	114843 (11.8%)	5216 (11%)	109247 (11.8%)	< 0.001
Hospital characteristics
Teaching hospital	514847 (52.9%)	28690 (60.5%)	486982 (52.6%)	< 0.001
Urban hospital	891493 (91.6%)	44387 (93.6%)	847128 (91.5%)	< 0.001
Hospital region
Northeast	177130 (18.2%)	6828 (14.4%)	170351 (18.4%)	< 0.001
Midwest	199515 (20.5%)	9911 (20.9%)	189793 (20.5%)	0.832
South	345502 (35.5%)	16692 (35.2%)	328667 (35.5%)	0.104
West	251097 (25.8%)	13989 (29.5%)	237010 (25.6%)	< 0.001
Hospital size
Small	122628 (12.6%)	4931 (10.4%)	118505 (12.8%)	< 0.001
Medium	258883 (26.6%)	12756 (26.9%)	246268 (26.6%)	0.002
Large	590760 (60.7%)	29734 (62.7%)	561048 (60.6%)	< 0.001
Hospital complications
Variceal bleed	114843 (11.8%)	4789 (10.1%)	110428 (11.9%)	< 0.001
HRS	22619 (7.2%)	14942 (23.8%)	75917 (8.2%)	< 0.001
Hepatic encephalopathy	321171 (33%)	24375 (51.4%)	322186 (34.8%)	< 0.001
Ascites	605359 (62.2%)	34191 (72.1%)	565677 (61.1%)	< 0.001
SBP	23357 (2.4%)	1659 (3.5%)	21293 (2.3%)	< 0.001
Hepatocellular carcinoma	60341 (6.2%)	5927 (12.5%)	49994 (5.4%)	< 0.001
NACSELD-ACLF score
0	495382 (50.9%)	11191 (23.6%)	482353 (52.1%)	< 0.001
1	389298 (40%)	22810 (48.1%)	366625 (39.6%)	< 0.001
2	64234 (6.6%)	8536 (18%)	56475 (6.1%)	< 0.001
3	22384 (2.3%)	4505 (9.5%)	18516 (2%)	< 0.001
4	973 (0.1%)	426(0.9%)	925 (0.1%)	< 0.001
ACLF ≥ 2	89538 (9.2%)	13420 (28.3%)	76843 (8.3%)	< 0.001
Mean ACLF score	0.64	1.21	0.61	< 0.001

HRS: Hepatorenal syndrome; SBP: Spontaneous bacterial peritonitis; NACSELD-ACLF: North American Consortium for the Study of End-Stage Liver Disease's definition of acute-on-chronic liver failure; ACLF: Acute-on-chronic liver failure.

Table 2 Multivariate regression for palliative consult

Variable	Adjusted odds ratio	95%CI	P value
Age	1.02	1.00-1.04	< 0.001
Median income in patient zip code
$1-$38999	Reference
$39000-$47999	1.07	0.98-1.16	0.117
$48000-$62999	0.99	0.9-1.08	0.983
> $63000	0.95	0.85-1.02	0.141
Female sex	1.07	1.00-1.14	0.023
Race
Caucasian	Reference
African Americans	0.81	0.72-0.9	< 0.001
Hispanic	0.71	0.64-0.78	< 0.001
Others	0.89	0.78-1.00	0.069
Charleson comorbidity index	1.1	1.08-1.12	< 0.001
Insurance status
Medicare	Reference
Medicaid	1.34	1.19-1.51	< 0.001
Private insurance	1.18	1.08-1.29	< 0.001
Uninsured	1.52	1.36-1.7	< 0.001
Teaching hospital	1.4	1.28-1.53	< 0.001
Bed size
< 250 beds	Reference
251-400 beds	1.24	1.09-1.42	0.001
> 400 Beds	1.25	1.1-1.41	< 0.001
Urban location	0.96	0.83-1.19	0.625
Length of stay by groups
< 3 d	Reference
3-5 d	0.92	0.84-1.00	0.065
> 5 d	1.18	1.10-1.26	< 0.001
Rehab transfer	4.07	3.29-5.04	< 0.001
ACLF Score
1	2.53	2.35-2.71	< 0.001
2	6.05	5.5-6.66	< 0.001
3	9.86	8.75-11.1	< 0.001
4	10.61	7.32-15.42	< 0.001
ACLF ≥ 2	3.47	3.21-3.74	< 0.001
Hepatocellular carcinoma	1.78	1.58-2.00	< 0.001
Infection	1.58	1.48-1.69	< 0.001
Mechanical ventilation	3.32	3.1-3.54	< 0.001
Total parenteral nutrition	2.02	1.8-2.27	< 0.001
Hepatorenal syndrome	3.4	3.04-3.81	< 0.001
Ascites	1.13	1.03-1.24	< 0.001
Spontaneous bacterial peritonitis	3.34	2.65-3.86	< 0.001
Age	1.02	1.00-1.04	< 0.001
Female sex	1.07	1.00-1.14	0.023
Race
Caucasian	Reference
African Americans	0.81	0.72-0.9	< 0.001
Hispanic	0.71	0.64-0.78	< 0.001
Others	0.89	0.78-1.00	0.069
Charleson comorbidity index	1.1	1.08-1.12	< 0.001
Insurance status
Medicare	Reference
Medicaid	1.34	1.19-1.51	< 0.001
Private insurance	1.18	1.08-1.29	< 0.001
Uninsured	1.52	1.36-1.7	< 0.001
Teaching hospital	1.4	1.28-1.53	< 0.001
Bed size
< 250 beds	Reference
251-400 beds	1.24	1.09-1.42	0.001
> 400 Beds	1.25	1.1-1.41	< 0.001
Urban location	0.96	0.83-1.19	0.625
Length of stay by groups
< 3 d	Reference
3-5 d	0.92	0.84-1.00	0.065
> 5 d	1.18	1.10-1.26	< 0.001
Rehab transfer	4.07	3.29-5.04	< 0.001
ACLF ≥ 2	3.47	3.21-3.74	< 0.001

ACLF: Acute-on-chronic liver failure.

Table 3 Results of regression analysis looking at the factors associated with 30-d readmission rate

Variable	Unadjusted odds ratio	95%CI	P value	Adjusted odds ratio	95%CI	P value
Palliative care	0.36	0.31-0.41	< 0.001	0.35	0.31-0.41	< 0.001
Patient characteristics
Age	0.99	0.99-0.99	< 0.001	0.99	0.99-0.99	< 0.001
Median income in patient zip code
$1-$38999	Reference
$39000-$47999	0.97	0.94-1.01	0.236
$48000-$62999	1	0.97-1.04	0.655
> $63000	1.02	0.99-1.06	0.133
Female sex	1.01	0.99-1.04	0.188
Race
Caucasian	Reference
African-Americans	0.77	0.52-1.12	0.175
Hispanic	0.93	0.65-1.34	0.721
Others	0.76	0.47-1.24	0.282
Mean charlson comorbidity index	1.04	1.03-1.04	< 0.001	1.06	1.05-1.06	< 0.001
Insurance status
Medicare	Reference
Medicaid	1.14	1.11-1.18	< 0.001
Private insurance	0.89	0.86-0.93	< 0.001
Uninsured	0.75	0.71-0.78	< 0.001
ACLF ≥ 2	0.89	0.84-0.95	0.001	0.86	0.81-0.91	< 0.001
Infection	1.07	1.04-1.10	< 0.001	1.09	1.07-1.13	< 0.001
Hospital characteristics
Teaching hospital	1.05	1.02-1.05	< 0.001	1.02	0.99-1.05	0.208
Bed size
< 250 beds	Reference
251-400 beds	1	0.95-1.06	0.723
> 400 Beds	1.02	0.97-1.07	0.37
Rural location	0.85	0.83-0.88	< 0.001	0.86	0.81-0.91	< 0.001

ACLF: Acute-on-chronic liver failure.