دورية أكاديمية
أعرض في EDS

Healthcare Resource Utilization and Goals of Care Discussions in Patients with Cirrhosis and Acute Kidney Injury.

التفاصيل البيبلوغرافية
العنوان: Healthcare Resource Utilization and Goals of Care Discussions in Patients with Cirrhosis and Acute Kidney Injury.
المؤلفون: Petrosyan R; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Endres P; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA., Ufere NN; Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., St Hillien SA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Krinsky S; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Kalim S; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Nigwekar SU; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Ouyang T; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA., Allegretti AS; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA. aallegretti@mgh.harvard.edu.
المصدر: Digestive diseases and sciences [Dig Dis Sci] 2024 Jun; Vol. 69 (6), pp. 1948-1955. Date of Electronic Publication: 2024 Mar 07.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Science + Business Media Country of Publication: United States NLM ID: 7902782 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-2568 (Electronic) Linking ISSN: 01632116 NLM ISO Abbreviation: Dig Dis Sci Subsets: MEDLINE
أسماء مطبوعة: Publication: 2005- : New York, NY : Springer Science + Business Media
Original Publication: New York, Plenum Pub. Corp.
مواضيع طبية MeSH: Liver Cirrhosis*/therapy , Liver Cirrhosis*/complications , Acute Kidney Injury*/therapy , Acute Kidney Injury*/mortality , Patient Care Planning*, Humans ; Male ; Female ; Middle Aged ; Prospective Studies ; Aged ; Liver Transplantation ; Health Resources/statistics & numerical data ; Patient Acceptance of Health Care/statistics & numerical data ; Critical Illness/therapy
مستخلص: Background: Patients with cirrhosis and acute kidney injury (AKI) are critically ill and have high health care resource utilization (HCRU). The impact and timing of goals of care discussions on HCRU are not well described.
Methods: 221 patients enrolled in a prospective cohort study of patients admitted with AKI and cirrhosis were reviewed. Documentation and timing of a goals of care discussions were analyzed as predictors of HCRU, defined as a composite outcome of intubation, initiation of renal replacement therapy, and/or admission to the intensive care unit.
Results: Median MELD score was 26 [IQR 19, 33]. 29% patients were listed for liver transplant. 90-day mortality was 61%. 51% patients had at least one HCRU episode. Code status changed from admission to discharge from 91%/7%/0% to 68%/14%18% (full code/do not resuscitate/comfort measures, p < 0.001). 28% patients underwent goals of care discussions, with change in code status at a median of 16 [9, 22] days into admission. Only 18% of discussions were within 7 days of admission and all were after an HCRU event. Being listed for liver transplant was not associated with whether goals of care discussions occurred (23% listed vs. 31% non-listed, p = 0.24) but was associated with higher HCRU (69% vs. 43%; p < 0.001).
Conclusion: Goals of care discussions occurred late into the hospital course, after episodes of HCRU. Efforts should be made to engage in these discussions earlier in the hospital stay, which may decrease HCRU rates in this critically ill population and align with patients' goals of care.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
References: Hepatology. 2019 Feb;69(2):729-741. (PMID: 30141205)
Clin Gastroenterol Hepatol. 2021 Apr;19(4):646-656.e3. (PMID: 33221550)
Hepatology. 2022 Sep;76(3):819-853. (PMID: 35103995)
Dig Dis Sci. 2016 Dec;61(12):3609-3620. (PMID: 27655105)
Clin Gastroenterol Hepatol. 2014 Apr;12(4):692-8. (PMID: 23978345)
JAMA Intern Med. 2014 Dec;174(12):1994-2003. (PMID: 25330167)
Hepatology. 2008 Dec;48(6):2064-77. (PMID: 19003880)
Clin Gastroenterol Hepatol. 2017 Oct;15(10):1612-1619.e4. (PMID: 28179192)
J Pain Symptom Manage. 2020 Mar;59(3):590-598. (PMID: 31655192)
J Crit Care. 2009 Dec;24(4):629.e1-12. (PMID: 19327312)
Am J Transplant. 2021 Feb;21 Suppl 2:208-315. (PMID: 33595192)
J Hepatol. 2013 Sep;59(3):474-81. (PMID: 23669284)
N Engl J Med. 2009 Sep 24;361(13):1279-90. (PMID: 19776409)
Clin Gastroenterol Hepatol. 2019 Nov;17(12):2592-2599. (PMID: 30885884)
Liver Transpl. 2007 Jun;13(6):838-43. (PMID: 17539003)
Lancet Gastroenterol Hepatol. 2019 Jan;4(1):52-62. (PMID: 30472051)
J Hepatol. 2006 Jan;44(1):217-31. (PMID: 16298014)
Res Nurs Health. 2012 Oct;35(5):518-32. (PMID: 22581585)
N Engl J Med. 2010 Aug 19;363(8):733-42. (PMID: 20818875)
Int J Nephrol. 2015;2015:108139. (PMID: 26266048)
JAMA Intern Med. 2021 May 1;181(5):652-660. (PMID: 33720273)
Am J Hosp Palliat Care. 2019 Dec;36(12):1049-1056. (PMID: 30983374)
Clin Gastroenterol Hepatol. 2018 Jan;16(1):142-143. (PMID: 28711690)
Clin Gastroenterol Hepatol. 2019 Oct;17(11):2339-2346.e1. (PMID: 30743007)
World J Transplant. 2016 Sep 24;6(3):594-8. (PMID: 27683638)
Clin Transl Gastroenterol. 2021 May 11;12(5):e00359. (PMID: 33979307)
Gut. 2015 Apr;64(4):531-7. (PMID: 25631669)
معلومات مُعتمدة: K23 DK128567 United States DK NIDDK NIH HHS
فهرسة مساهمة: Keywords: End of life; Hepatorenal syndrome; Liver failure; Palliative care
تواريخ الأحداث: Date Created: 20240307 Date Completed: 20240608 Latest Revision: 20240610
رمز التحديث: 20240610
مُعرف محوري في PubMed: PMC11162308
DOI: 10.1007/s10620-024-08317-9
PMID: 38451428
قاعدة البيانات: MEDLINE
الوصف
تدمد:1573-2568
DOI:10.1007/s10620-024-08317-9