REHOSPITALIZATION AS AN INDICATOR OF INADEQUATE SURVEILLANCE IN LIVER CIRRHOSIS

Abstract

Introduction. In the Republic of Moldova, the prevalence of delta viral hepatitis remains high, constituting a major public health problem. In the absence of modern and effective etiological treatment, the management of patients with delta viral cirrhosis is based almost exclusively on rigorous surveillance and prevention of decompensation.

Aim. To evaluate rehospitalization as a pragmatic marker of insufficient monitoring in delta viral cirrhosis and to validate a “Risk Index for Decompensation” applicable at discharge.

Material and methods. A cohort study was conducted with two independent sets of adult patients with delta viral liver cirrhosis (HC HDV), discharged from a tertiary hospital and undergoing surveillance for a duration of ≥12 months. Exclusion criteria were: other associated liver diseases (autoimmune hepatitis, cholestatic liver diseases, hepatitis C). The derivation cohort (DC) consisted of 131 patients with HC HDV, discharged between 2021-2025 and the validation cohort (VC) included 100 patients with HC HDV, discharged between 2013-2019. Decompensation was defined as a composite parameter and presented as: ≥1 of the following: (re)hospitalization, ascites, hepatic encephalopathy (HE) or variceal hemorrhage.

Results. In DC, the mean age was 54.84 ± 9.54 years, with a male predominance – 53%. In CV – the mean age was 52.2 ± 11.26 years, 51.7% - male. Over a 12-month period, 82% of patients in DC and 39% in CV presented at least one episode of decompensation, and 52% and 55% respectively required (re)hospitalization. Predictors for decompensation and rehospitalization are: male gender (OR = 8.05; 95% CI: 2.01–213.66), portal thrombosis (OR = 142.54; 95% CI: 1.03–552.00), thrombocytopenia (OR = 10.41; 95% CI: 1.88–232.53). The risk index was found to be a significant predictor of rehospitalization (OR=26.65, 95% CI: 3.628–195.768), suggesting a strong association with the need for surveillance in patients with delta viral liver cirrhosis.

Conclusions. Rehospitalization is a pragmatic indicator of insufficient monitoring in delta viral cirrhosis. The decompensation index, simple and externally validated, can be applied at discharge for risk stratification and adjustment of follow-up intensity in delta viral liver cirrhosis.