Evidence map›Paper›PMID 39181424›Full record

ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2025

Emergency Department Utilization and Outcomes Among Adults With Cirrhosis From 2008 to 2022 in the United States.

Hirsh Elhence, Jennifer L Dodge, Jennifer A Flemming, Brian P Lee

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Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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4citing papers in PubMed
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1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Hirsh ElhenceKeck School of Medicine, University of Southern California, Los Angeles, California.
Jennifer L DodgeDepartment of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Division of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California.
Jennifer A FlemmingDepartments of Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Brian P LeeDivision of Gastroenterology and Liver Diseases, University of Southern California, Los Angeles, California. Electronic address: brian.lee@med.usc.edu.

Funding

USC RESEARCH CENTER FOR LIVER DISEASES: PILOT PROGRAMSP30DK048522 · NIDDK · UNIVERSITY OF SOUTHERN CALIFORNIA · PI HAMM-ALVAREZ, SARAH F · 1995 to 2020
$21.8M
1/4-American Consortium of Early Liver Transplantation-Prospective Alcohol-associated liver disease Cohort Evaluation (ACCELERATE-PACE)R01AA030960 · NIAAA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI Norah A. Terrault · 2023 to 2026
$2.3M
Estimating the Contribution of Alcohol and Metabolic Risk to Liver Disease Progression to Inform Personalized InterventionsK23AA029752 · NIAAA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI LEE, BRIAN PEI LIM · 2022 to 2025
$772k
NIAAA NIH HHS K23 AA029752NIAAA NIH HHS R01 AA030960NIDDK NIH HHS P30 DK048522
6 · The paper itself

Abstract

BACKGROUND &

aimsGlobally, emergency departments (ED) are experiencing rising costs and crowding. Despite its importance, ED utilization and outcomes among patients with cirrhosis are understudied.

methodsWe analyzed Optum's de-identified Clinformatics Data Mart Database, between 2008 and 2022, including adults with at least 180 days of enrollment. Liver transplant recipients were censored at the year of transplant. ED visits (stratified by liver vs non-liver related) were identified using validated billing code definitions. Linear regression was used to assess ED visits per year, and logistic regression was used to assess 90-day mortality rates and discharge dispositions, with models adjusted for patient- and visit-level characteristics.

resultsAmong 38,419,650 patients, 198,439 were with cirrhosis (median age, 66 [interquartile range, 57-72 years]; 54% male; 62% White). In age-adjusted analysis, ED visits per person-year were 1.72 (95% confidence interval [CI], 1.71-1.74) with cirrhosis vs 0.46 (95% CI, 0.46-0.46) without cirrhosis, 1.66 (95% CI, 1.66-1.66) for congestive heart failure (CHF), and 1.22 (95% CI, 1.22-1.22) for chronic obstructive pulmonary disease (COPD). Age-adjusted 90-day mortality rates were 12.2% (95% CI, 12.1%-12.4%) with cirrhosis vs 4.8% [95% CI, 4.8%-4.8%) without cirrhosis, 6.9% (95% CI, 6.9%-6.9%) for CHF, and 6.3% (95% CI, 6.3%-6.4%) for COPD. Non-liver (vs liver-related) ED visits were more likely to lead to discharge home among patients with compensated (52.8%; 95% CI, 52.2%-53.5% vs 39.2%; 95% CI, 38.5%-39.8%) and decompensated (42.2%; 95% CI, 41.5%-42.8% vs 29.5%; 95% CI, 29.0%-30.1%) cirrhosis. In exploratory analysis, among patients who remained alive and were not readmitted for 30 days after ED discharge, those without any outpatient follow-up had higher 90-day mortality (22.0%; 95% CI, 21.0%-23.0%) than those with both primary care and gastroenterology/hepatology follow-up within 30-days (7.9%; 95% CI, 7.3%-8.5%).

conclusionsPatients with cirrhosis have higher ED utilization and almost 2-fold higher post-ED visit mortality than CHF and COPD. These findings provide impetus for ED-based interventions to improve cirrhosis-related outcomes.

Indexed as

Emergency Service, HospitalLiver CirrhosisAdultAgedFemaleHumansMaleMiddle AgedUnited StatesCirrhosisDatabaseEmergency DepartmentMortalityOutpatient Follow-up

Identifiers

PMID39181424
PMCPMC11846955

What OpenQuestion holds

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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.