Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization : A Prospective Multi-Center Cohort of Outpatients With Cirrhosis
Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved..
BACKGROUND & AIMS: Hospitalizations 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.
METHODS: North 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.
RESULTS: A 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.
CONCLUSIONS: In 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association - 21(2023), 7 vom: 01. Juli, Seite 1864-1872.e2 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bajaj, Jasmohan S [VerfasserIn] |
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| Links: |
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| Themen: |
Eradicated Hepatitis C |
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| Anmerkungen: |
Date Completed 26.06.2023 Date Revised 26.06.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.cgh.2022.10.023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM348422342 |
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| 100 | 1 | |a Bajaj, Jasmohan S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization |b A Prospective Multi-Center Cohort of Outpatients With Cirrhosis |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 26.06.2023 | ||
| 500 | |a Date Revised 26.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND & AIMS: Hospitalizations 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 | ||
| 520 | |a METHODS: North 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 | ||
| 520 | |a RESULTS: A 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 | ||
| 520 | |a CONCLUSIONS: In 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Eradicated Hepatitis C | |
| 650 | 4 | |a Frailty | |
| 650 | 4 | |a Minimal Hepatic Encephalopathy | |
| 650 | 4 | |a North American Consortium for Study of End-stage Liver Disease | |
| 650 | 4 | |a Periodontitis | |
| 700 | 1 | |a Lai, Jennifer C |e verfasserin |4 aut | |
| 700 | 1 | |a Tandon, Puneeta |e verfasserin |4 aut | |
| 700 | 1 | |a O'Leary, Jacqueline G |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Florence |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia-Tsao, Guadalupe |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas, Hugo E |e verfasserin |4 aut | |
| 700 | 1 | |a Kamath, Patrick S |e verfasserin |4 aut | |
| 700 | 1 | |a Biggins, Scott W |e verfasserin |4 aut | |
| 700 | 1 | |a Limon-Miro, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Shaw, Jawaid |e verfasserin |4 aut | |
| 700 | 1 | |a Mbachi, Chimezie |e verfasserin |4 aut | |
| 700 | 1 | |a Chew, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Golob Deeb, Janina |e verfasserin |4 aut | |
| 700 | 1 | |a Thacker, Leroy R |e verfasserin |4 aut | |
| 700 | 1 | |a Reddy, K Rajender |e verfasserin |4 aut | |
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