Evidence map›Paper›PMID 32146602›Full record

ArticleDigestive diseases and sciences2020

Underutilization of Hospice in Inpatients with Cirrhosis: The NACSELD Experience.

Jacqueline G O'Leary, Puneeta Tandon, K Rajender Reddy, Scott W Biggins, Florence Wong, Patrick S Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer Lai, Michael Fallon and 5 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Digestive diseases and sciences, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Consider hospice in end-stage liver disease prognostic scale to open discussions regarding six-month mortality.JGH open : an open access journal of gastroenterology and hepatology · 2023
    Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 13 institutions in 2 countries.

Jacqueline G O'LearyDepartment of Medicine, Dallas VA Medical Center, Dallas, TX, USA. dr_jackieo@yahoo.com.
Puneeta TandonDepartment of Medicine, University of Alberta, Edmonton, AB, Canada.
K Rajender ReddyDepartment of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Scott W BigginsDepartment of Medicine, University of Washington, Seattle, WA, USA.
Florence WongDepartment of Medicine, University of Toronto, Toronto, ON, Canada.
Patrick S KamathDepartment of Medicine, Mayo Clinic, Rochester, MN, USA.
Guadalupe Garcia-TsaoDepartment of Medicine, Yale University, New Haven, CT, USA.
Benedict MaliakkalDepartment of Medicine, University of Rochester, Rochester, NY, USA.
Jennifer LaiDepartment of Medicine, University of California, San Francisco, CA, USA.
Michael FallonDepartment of Medicine, University of Texas, Health Science Center, Houston, TX, USA.
Hugo E VargasDepartment of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Paul ThuluvathDepartment of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Ram SubramanianDepartment of Medicine, Emory University, Atlanta, GA, USA.
Leroy R ThackerDepartment of Biostatistics, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, VA, USA.
Jasmohan S BajajDepartment of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, VA, USA.
Mayo Clinic in Arizona · USVirginia Commonwealth University · USDallas VA Medical Center · USEmory University · USThe University of Texas Health Science Center at Houston · USUniversity of Alberta · CAUniversity of California, San Francisco · USUniversity of Maryland, Baltimore · USUniversity of Pennsylvania · USUniversity of Rochester · USUniversity of Toronto · CAUniversity of Washington · USYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLittle is known about patients discharged to hospice following hospitalization for complications of cirrhosis.

aimWe sought to understand the current pattern of hospice utilization in patients with cirrhosis by evaluating the North American Consortium for the Study of End-stage Liver Disease (NACSELD) cohort.

methodsPatients with cirrhosis from 14 tertiary-care hepatology centers across North America non-electively hospitalized and prospectively enrolled were evaluated. Exclusion criteria included HIV infection, transplantation or non-hepatic malignancy. Random computer-based propensity score matching was undertaken in a 1:2 ratio based on admission MELD score ± 3 points.

resultsTotally, 2718 patients were enrolled, 5% (N = 132) were discharged to hospice, 6% (N = 171) died, and the rest were discharged alive. Patients discharged to hospice were older (60 vs. 57 years, p = 0.04), less likely to have had SBP (13% vs. 28%, p = 0.002) and be listed for liver transplantation (11% vs. 26%, p = 0.0007). Features, on multivariable modeling, associated with increased probability of discharge to hospice as opposed to being discharged alive: grade-3-4 hepatic encephalopathy, a higher Child-Turcotte-Pugh (CTP) score, and a higher discharge serum creatinine; however, a higher serum sodium, being listed for transplant and being prescribed rifaximin or a statin were protective from hospice discharge.

conclusionPatients with more advanced liver disease, hepatic encephalopathy, renal dysfunction, and those not candidates for liver transplantation were more likely to be discharged to hospice. However, in this sick multinational cohort of cirrhotic inpatients, it seems that hospice is markedly underutilized (5%) since 25% of patients not discharged to hospice died within 6 months.

Indexed as

InpatientsAgedFemaleHealth Services MisuseHealth StatusHospice CareHospital MortalityHumansLiver CirrhosisMaleMiddle AgedNorth AmericaPalliative CarePatient DischargeProspective StudiesQuality Indicators, Health CareACLFCirrhosisDecompensationNACSELDPalliative care

Identifiers

PMID32146602
OpenAlexW3009266093

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.