Olivia Belliveau, Catherine Mezzacappa, Arpan Patel, Jennifer Kapo, David Kaplan, Tamar Taddei
Inpatient PC services may be underutilized in AH. PC consultation was associated with more comorbid illness and mortality, suggesting PC services are targeted toward patients nearing death. Black patients were less likely to receive PC.
BACKGROUND: Acute alcohol-associated hepatitis (AH) carries a high mortality risk. Little is known about utilization of specialty palliative care (PC) consultation in AH.
OBJECTIVES: In a cohort of Veterans hospitalized with AH, we aimed to characterize predictors of PC consultation and short-term mortality.
DESIGN/SETTING/SUBJECTS: This was a national retrospective cohort study (United States) of Veterans Health Administration patients with abnormal liver enzyme measurements hospitalized between 2008 and 2022. We used a validated algorithm to identify first hospitalizations with AH.
MEASUREMENTS: Descriptive statistics were tabulated. In multivariable analyses, we identified factors associated with PC consultation, in-hospital mortality, and post-discharge mortality.
RESULTS: We identified 3907 first AH hospitalizations. Overall, 670 patients (17.2%) received a PC consult, with no significant temporal trend in PC consult use between 2008 and 2022. Most consults (71.9%) occurred late, after three days of hospitalization. In multivariable analysis, predictors of receiving PC included older age (odds ratio [OR:] for a five-year increase: 1.26, p < 0.001), another or unknown race or ethnicity (OR: 1.38, p = 0.016), and higher MELD 3.0 score (OR: for a five-point increase: 2.22, p < 0.001). Black Veterans were less likely to receive a PC consult compared to White Veterans (OR: 0.53, p < 0.001). Veterans who received a specialty PC consult were more likely to die while hospitalized (30.2% vs. 3.7%, p < 0.001) and within 60 days of discharge (38.7% vs. 11.4%, p < 0.001). In multivariable analysis, PC consultation (OR: 4.30, p < 0.001), age (OR: for a five-year increase: 1.20, p < 0.001), another race or ethnicity (OR: 1.47, p = 0.001), and MELD 3.0 score (OR: 1.49, p < 0.001) were associated with 60-day post-discharge mortality.
CONCLUSION: Inpatient PC services may be underutilized in AH. PC consultation was associated with more comorbid illness and mortality, suggesting PC services are targeted toward patients nearing death. Black patients were less likely to receive PC.