Author information

• ¹Department of Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, USA. Electronic address: jasmohan.bajaj@vcuhealth.org.
• ²Department of Medicine, University of California, San Francisco, USA.
• ³Department of Medicine, University of Alberta, Edmonton, Canada.
• ⁴Department of Medicine, Dallas VA Medical Center, Dallas, USA.
• ⁵Department of Medicine, University of Toronto, Toronto, Canada.
• ⁶Department of Medicine, West Haven VA Medical Center, West Haven, USA.
• ⁷Department of Medicine, Mayo Clinic, Phoenix, USA.
• ⁸Department of Medicine, Mayo Clinic, Rochester, USA.
• ⁹Department of Medicine, University of Washington, Seattle, USA.
• ¹⁰Department of Medicine, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, USA.
• ¹¹Department of Periodontics, Virginia Commonwealth University, Richmond, USA.
• ¹²Department of Biostatistics, Virginia Commonwealth University, Richmond, USA.
• ¹³Department of Medicine, University of Pennsylvania, Philadelphia, USA.

Abstract

Hospitalizations are a sentinel event in cirrhosis; however, the changing cirrhosis demographics in require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. AIM: Determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of cirrhosis outpatients. NACSELD-3 (North American Consortium for Study of End-stage Liver disease), a new study cohort, recruits outpatients with cirrhosis. Cirrhosis details, demographics, minimal hepatic encephalopathy (MHE), frailty, co-morbid conditions including oral health were collected. All patients were followed for 3-months for non-elective hospitalizations. Multi-variable models were created for this outcome using demographics, cirrhosis details, oral health, MHE, frailty and co-morbid conditions with K-fold internal validation using 25%/75% split. 442 outpatients (70% men, 37% compensated, MELD-Na 12, 42% ascites and 33% prior HE) were included. MHE was found in 70%, frailty in 10%; 8% with both. Oral health: 15% were edentulous and 10% had prior periodontitis. 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: Prior periodontitis (p=0.026), composite MHE+frailty score (p=0.0016), ascites (p=0.004), prior HE (0.008). hydrothorax (p=0.004) 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.