Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis

Abstract

Background & Aims Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions. Methods We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction. Results 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher MELD, discharge with public transportation, and impaired basic activities of daily living and quality of life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared to a model including only clinical variables, addition of functional status and quality of life variables improved the area under the receiver operating characteristic curve (AUROC) from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared to clinical variables alone. Compared to a model using electronically-available variables only, no models improved prediction when examined with integrated discrimination improvement. Conclusions PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.