ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2023
Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- AASLD AST Practice Guideline on adult liver transplantation: Candidate evaluation.Hepatology (Baltimore, Md.) · 2026Guideline
- Periodontal health status in cirrhotic patients: a systematic review and meta-analysis.BMC oral health · 2023Pooled it
- A global consensus on the critical care management of acute-on-chronic liver failure patients: the APASL ACLF Beijing Position Paper.Hepatology international · 2026Article
- Frailty Increases Hospitalization Rates in an Ambulatory Cohort of Patients With Cirrhosis: The North American Consortium for the Study of End-Stage Liver Disease 3 Prospective Cohort.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Dental prophylactic interventions are associated with lower decompensation-related hospitalizations over 2 years in cirrhosis.JHEP reports : innovation in hepatology · 2026Article
- Usefulness of the Stroop test in predicting decompensation events in patients with cirrhosis: A prospective cohort study.Scientific reports · 2026Article
- Psychomotor Speed From Minimal Hepatic Encephalopathy Testing Is Associated With Physical Frailty in Patients With Advanced Chronic Liver Disease.The American journal of gastroenterology · 2026Article
- A National Survey Shows a Dilemma Toward Spontaneous Bacterial Peritonitis Prophylaxis Among US-Based Hepatology Professionals.Clinical and translational gastroenterology · 2025Article
- Microbial Approaches to Treat and Prevent Hepatic Encephalopathy.Gastroenterology clinics of North America · 2025Review
- The Multi-dimensional Challenge of Poor Oral Health in Cirrhosis-Disparities and Solutions.Gastroenterology · 2024Article
- Hospital frailty risk score is superior to legacy comorbidity indices for risk adjustment of in-hospital cirrhosis cases.JHEP reports : innovation in hepatology · 2024Article
- The prevalence and characteristics of frailty in cirrhosis patients: a meta-analysis and systematic review.Frontiers in medicine · 2024Article
- High incidence of periodontitis in patients with ascitic decompensated cirrhosis.World journal of hepatology · 2023Article
- Liver Transplantation: Protocol for Recipient Selection, Evaluation, and Assessment.Journal of clinical and experimental hepatologyReview
- Dental and ENT Evaluation Before Liver Transplantation.Journal of clinical and experimental hepatologyReview
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Authors and funding
16 authors at 10 institutions in 2 countries.
Funding
Abstract
BACKGROUND &
aimsHospitalizations are a sentinel event in cirrhosis; however, the changing demographics in patients with cirrhosis require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. The aim of this study was to determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of outpatients with cirrhosis.
methodsNorth American Consortium for Study of End-stage Liver Disease (NACSELD-3), a new study cohort, recruits outpatients with cirrhosis. Cirrhosis details, demographics, minimal hepatic encephalopathy (MHE), frailty, and comorbid conditions including oral health were collected. All patients were followed for 3 months for nonelective hospitalizations. Multi-variable models were created for this outcome using demographics, cirrhosis details, oral health, MHE, frailty, and comorbid conditions with K-fold internal validation using 25%/75% split.
resultsA total of 442 outpatients (70% men; 37% compensated; Model for End-stage Liver Disease-Sodium, 12; 42% ascites; and 33% prior HE) were included. MHE was found in 70%, frailty in 10%; and both in 8%. In terms of oral health, 15% were edentulous and 10% had prior periodontitis. Regarding 3-month hospitalizations, 14% were admitted for mostly liver-related reasons. These patients were more likely to be decompensated with higher cirrhosis complications, MHE, frailty and periodontitis history. Multi-variable analysis showed prior periodontitis (P = .026), composite MHE + frailty score (P = .0016), ascites (P = .004), prior HE (P = .008), and hydrothorax (P = .004) were associated with admissions using the training and validation subsets.
conclusionsIn a contemporaneous, prospective, multi-center cohort study in outpatients with cirrhosis, poor oral health is significantly associated with 3-month hospitalizations independent of portal hypertensive complications, MHE, and frailty. Potential strategies to reduce hospitalizations should consider oral evaluation in addition to MHE and frailty assessment in practice pathways.
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