REACT Score, a Novel Scoring System, Improves the Prediction of Non‐Elective Readmissions in Patients With Decompensated Cirrhosis

BACKGROUND AND AIM: One third of patients with cirrhosis experience an early readmission, and predicting such an event is challenging. We developed and validated a scoring system to predict non-elective readmissions in patients with cirrhosis. METHODS: An observational and multicenter retrospective study enrolled 1382 consecutive non electively admitted patients with cirrhosis and acute decompensation from 20 centers in Spain and were categorized as derivation and validation cohorts. The cohorts were followed for 90 days after discharge. RESULTS: The rate of 7-day, 30-day and 90-day readmission was 5.3%, 19.9% and 36.7%, respectively, while 12.3% of patients died during the study. History of decompensation [HR 1.31 (95% CI 1.04-1.64); p = 0.022], Charlson index [HR 1.08 (95% CI 1.02-1.14); p = 0.012], large-volume paracentesis [HR 1.37 (95% CI 1.09-1.73); p = 0.007], INR [HR 1.52 (95% CI 1.17-1.97); p = 0.001] and bilirubin [HR 1.03 (95% CI 1.001-1.05); p = 0.045] at prior discharge were associated with early readmission. REACT score distinguished patients at high versus low risk of readmission: (a) derivation cohort 19.6% vs. 0% for 7-day, 70.6% vs. 2.5% for 30-day, 91.1% vs. 20.2% for 90-day; (b) internal validation 20.6% vs. 0% for 7-day, 58.8% vs. 0.5% for 30-day, 72.1% vs. 11.8% for 90-day; (c) external validation 5.8% vs. 0% for 7-day, 24.6% vs. 0% for 30-day, 44.2% vs. 12% for 90-day. Also, high-risk patients were more likely to be readmitted before their scheduled follow-up appointment (51.9% vs. 5.7%). CONCLUSIONS: Cirrhosis readmission rate was 20% within the first 30 days after discharge. REACT score effectively predicted the risk of non-elective readmission in patients with decompensated cirrhosis. Prospective studies are needed to fully assess the usefulness of this scoring system in predicting non-elective readmissions and in developing strategies to prevent them.